Adrian E. Vallejo, BS
Medical Student
UCSF School of Medicine
San Francisco, California, United States
Conor O'Neill, MD
Professor Physical Medicine and Rehabilitation Spine
University of California, San Francisco
San Francisco, California, United States
Emilia De Marchis, MD, MAS
Assistant Professor
UCSF
San Francisco, California, United States
Karina Del Rosario, MD
Associate Clinical Professor, Department of Orthopedic Surgery, Physical Medicine & Rehabilitation
University of California, San Francisco
San Francisco, California, United States
Masato Nagao, MD
Professor
Department of Orthopaedic Surgery, University of California San Francisco
San Francisco, California, United States
Tigist Belaye, MA
Clinical Research Manager
University of California San Francisco
San Francisco, California, United States
Amy Kuang, BS
Assistant Clinical Research Coordinator
University of California, San Francisco
Daly City, California, United States
Jan M. Yeager, MDes
Lead Service Designer
University of California San Francisco
San Francisco, California, United States
David Gendelberg, MD
Assistant Professor
University of California, San Francisco
San Francisco, California, United States
Jeffrey Lotz, PhD
Professor in Basic Translational Research
University of California, San Francisco
San Francisco, California, United States
Patricia Zheng, MD
Associate Orthopaedics Clinical Professor and Physical Medicine and Rehabilitation Specialist
University of California, San Francisco
San Francisco, California, United States
Chronic low back pain (cLBP) is a leading disability that is disproportionately borne by populations experiencing socioeconomic marginalization. Patients preferring to speak non-English languages may face additional difficulties managing cLBP related to disparate healthcare experiences, trust, health literacy, and other social determinants of health (SDOH). We explored the healthcare and self-management experiences of Spanish and Cantonese-speaking patients with cLBP.
Design:
Mixed method study of patients meeting the NIH Research Task Force recommended definition of cLBP were recruited from an urban county hospital. Sociodemographic information was tabulated and participants were surveyed on 3-Item Pain average, interference with Enjoyment of life, and interference with General activity (PEG), and provider trust. Three focus groups were conducted in each language probing on healthcare experiences and self-management preferences. Thematic analysis identified emergent themes.
Results:
Twenty-seven participants were included (18 female). Eighteen (66%) identified as Hispanic and Spanish-speaking and 9 (33%) identified as Asian and Cantonese-speaking. 75% of participants were below federal poverty threshold; 63% completed less than high school; 59% had access to smartphone and internet. Participants reported moderate disability (PEG mean 6.82±SD 2.49). Focus groups generated enthusiasm for digitally accessible materials and identified three emergent themes. First, both language groups faced difficulties accessing and navigating healthcare systems, related to SDOH. Second, while reporting high provider trust (mean 9.5± SD 1.1; 10 is highest), participants raised concern that providers were unaware of their pain etiologies contributing to skepticism in care. Third, participants were motivated to self-manage cLBP, but require additional support, including assistance filtering through online information.
Conclusions:
Results suggest that Spanish and Cantonese-speaking patients with cLBP face additional difficulties accessing and navigating care and finding trustworthy self-help information. This research is one of first to specifically explore unique needs of often-overlooked populations. Further work is needed to design interventions to reduce cLBP outcome disparities affecting these groups.
