Study assesses musculoskeletal health needs of underserved patients

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

Critical issues included a lack of health education and awareness about the management of 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, causing financial and social burdens, especially in underserved communities. Studies show that disparities in musculoskeletal health disproportionately affect women, older adults, and racial/ethnic minorities.”

Titilayo Adeniran, MPH, Director of Results and Data Analytics, HSS Education Institute

HSS researchers used a mixed-methods approach to develop a community health needs assessment (CHNA). “For quantitative data, we disseminated 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 utilization and access to care; and health education needs,” Adeniran explained. “For qualitative data, we conducted interviews with 22 community partners, including community organizations, city and state agencies, and universities.”

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

In addition to surveys, interviews with community partners provided valuable insight into unmet health needs, Adeniran noted. Community organizations represented New York’s five boroughs, as well as surrounding areas serving racially/ethnically diverse populations. They represented all ages, genders and socio-economic groups.

Main conclusions:

  • Chronic pain, osteoarthritis or another form of arthritis were the most common musculoskeletal conditions reported in the survey.
  • Among respondents with musculoskeletal conditions, a lack of confidence in symptom management emerged as a health need, especially among medically underserved community members.
  • Nearly a third of all respondents said they had fallen in the past year.
  • People with chronic pain, fibromyalgia or lupus were more likely to report two or more weeks of poor physical and mental health.
  • Medically underserved respondents with a diagnosis of lupus, chronic pain, or rheumatoid arthritis were more likely to have used a prescription opioid to manage pain.
  • Health education emerged as a top need, with 70% of respondents saying they had not attended any health education in the past 12 months. The main reasons were fear of COVID-19 and not knowing about educational programs.
  • The top issues impacting respondents’ health and well-being were COVID-19 issues, social isolation/loneliness, limited places to exercise, and limited access to healthy food.
  • The survey identified a need to address access to healthcare, with 42% of respondents saying they had not been able to access healthcare in the past 12 months, compared to 8% in a survey conducted in 2019. The main 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 did not listen to the respondent. More than half of survey respondents mentioned this problem.

“Broad community engagement is critical to the success of any CBPR approach when assessing community health needs and identifying health disparities,” said Sandra Goldsmith, MA, MS, RD, vice – Deputy President of the HSS Education Institute. “The results of our study will allow us to raise awareness of the disparities that continue to affect our diverse and underserved populations and help us develop community initiatives to promote health equity.”

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


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