Study finds chronic-pain management, falls and limited access to care are critical issues among medically underserved

To improve the health of a community, the first step is to identify its most pressing needs. To that end, in 2022 Hospital for Special Surgery (HSS) implemented a community-based participatory research (CBPR) approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs.

Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations.

The study, "Assessing Musculoskeletal Health Needs of Underserved Patients & Community Members Using a Community Based Participatory Research Approach," was presented virtually at ACR Convergence 2022, the annual meeting of the American College of Rheumatology in Philadelphia.

"Musculoskeletal disorders are the most prevalent health conditions in the United States, resulting in financial and social burdens, especially in underserved communities," explained Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute. "Studies show that musculoskeletal health disparities disproportionately affect women, older adults and racial/ethnic minorities."

HSS researchers used a mixed-method approach to develop a Community Health Needs Assessment (CHNA). "For quantitative data, we distributed a community survey in four languages—English, Spanish, Chinese and Russian—to assess the socio-demographic characteristics of the populations we serve; health status and quality of life; health behavior and lifestyle; use of and access to care; and health education needs," explained Adeniran. "For qualitative data, we conducted interviews with 22 community partners, including community-based organizations, city and state agencies and universities."

The survey was distributed in various ways, including online, via email, using Alchemer panels, in person, and through the mail over a four-week period from January 15 to February 15, 2022. A total of 18,248 patients and community members completed the surveys, with 57% representing a diverse and underserved population.

In addition to the surveys, interviews with community partners provided valuable insights into unmet health needs, Adeniran noted. Community organizations represented all five boroughs of New York City, as well as surrounding areas serving racially/ethnically diverse populations. They represented all age, gender, and socioeconomic groups.

Key findings:

• Chronic pain, osteoarthritis or another form of arthritis were the most common musculoskeletal conditions reported in the survey.
• Among respondents with a musculoskeletal condition, a lack of confidence in managing symptoms emerged as a health need, particularly among medically underserved community members.
• Almost one-third of all respondents reported falling in the past year.
• Those with chronic pain, fibromyalgia or lupus were more likely to report two or more weeks of poor physical and mental health.
• Medically underserved respondents diagnosed with lupus, chronic pain or rheumatoid arthritis were more likely to have used a prescription opioid to manage pain.
• Health education emerged as a major need, with 70% of respondents reporting no participation in health education in the past 12 months. The top reasons were fear of COVID-19 and not knowing about educational programs.
• The top issues impacting respondents' health and well-being were COVID-19 related issues, social isolation/loneliness, limited places to exercise, and limited access to healthy foods.
• The survey identified a need to address access to healthcare, with 42% of respondents reporting they could not access healthcare in the past 12 months, compared to 8% in a previous survey conducted in 2019. The top barriers were difficulty getting an appointment, lack of affordability or a service not covered by insurance. The need for transportation was also cited among the medically underserved.
• The most common type of discrimination reported in medical settings was that a doctor or nurse was not listening to the respondent. More than half of those taking the survey cited this issue.

"Broad community engagement is crucial to the success of any CBPR approach when assessing the health needs of the community and identifying health disparities," said Sandra Goldsmith, MA, MS, RD, assistant vice president at the HSS Education Institute. "The results of our study will enable us to raise awareness about disparities that continue to affect our diverse and underserved populations and help us develop community-based initiatives to promote health equity."

Titilayo Adeniran, Bertilia Trieu, Sandra Goldsmith and Laura Robbins, Hospital for Special Surgery, New York, NY.