Pain is a major risk factor for reduced physical activity (PA),1 disability, and mortality,2 and is especially common among older adults of lower socio-economic status.3 Occupational Therapy (OT) interventions have potential to reduce pain and improve function and activity using a unique approach that addresses environmental, physical, and psychological barriers.4 Pain however, is also a driver of PA intervention dropout.5 Research is needed to identify mechanisms that sustain participation in behavioral interventions when barriers such as pain are present. Social ties affect health behaviors and have particularly powerful effects among lower income older adults and those with chronic health problems.6,7 This project proposes an innovative pairing of a social network-based approach that systematically identifies and involves influential human agents of change in a community (i.e., the most socially engaged residents) to sustain participation in an OT intervention. A Stage 1 pilot study is proposed to test feasibility of pairing a social-network based approach with an eight-week OT intervention administered remotely with racially/ethnically diverse older adults living in subsidized senior housing. The goal of the intervention is to increase physical function and activity through development of habits and skills that address barriers such as pain. Remote interventions in this setting are needed due to prevalence of functional health limitations and residents who do not leave their apartments often. This pilot study has three aims: 1) Identify agents of change (AoC) and implement intervention. Within two sequential cohorts of 12 residents, AoC will: 1) be identified as the top two in their cohort in terms of number of residents who report knowing them; and 2) be invited to form an Organizing Committee tasked with encouraging others in the cohort to participate in intervention activities. 2) Evaluate feasibility of intervention implementation. Qualitative data on facilitators and barriers to participation will be analyzed and the following process hypotheses will be tested H2a: At least 75% (3 of 4) identified AoCs will accept invitation to serve on committee; H2b: AoC will attend at least 2 of 3 committee meetings; H2c: Participants will on average participate in at least 75% (18 of 24) of intervention activities. 3) Examine changes in secondary outcomes and differences in process and secondary outcomes by whether knew an AoC at baseline. Secondary outcomes (physical function, PA, pain) will be measured via self-report pre and post intervention. PA will also be measured using wearable activity monitors. The following hypotheses based on Social Contagion Theory and the Convoy Model of Social Relations will be tested: H3a-Network influence: Residents knowing 1+ committee members at baseline will participate in more intervention activities compared to those who do not. H3b-Pain as modifier: The network influence on participation will be greater among residents reporting more pain at baseline. This Stage 1 pilot feasibility study complements the PI?s NIA funded K01 by leveraging interpersonal and social processes to promote behavior change among lower income older adults.
Funding:
Joan & Sanford I. Weill Medical College of Cornell University
Funding Period:
06/01/2021 to 05/31/2024