Measuring pain in the context of homelessness
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The primary objective of this study was to inform the development of measures of pain impact appropriate for all respondents, including homeless individuals, so that they can be used in clinical research and practice. The secondary objective was to increase understanding about the unique experience of homeless people with pain.
Seventeen homeless individuals with chronic health conditions (often associated with pain) participated in cognitive interviews to test the functioning of 56 pain measurement items and provided information about their experience living with and accessing treatment for pain.
The most common problems identified with items were that they lacked clarity or were irrelevant in the context of homelessness. Items that were unclear, irrelevant and/or had other identified problems made it difficult for participants to respond. Participants also described multiple ways in which their pain was exacerbated by conditions of homelessness and identified barriers to accessing appropriate treatment.
Results suggested that the majority of items were problematic for the homeless and require substantial modifications to make the pain impact bank relevant to this population. Additional recommendations include involving homeless in future item bank development, conducting research on the topic of pain and homelessness, and using cognitive interviewing in other types of health disparities research.
KeywordsHomeless Pain Pain measurement Psychometrics Patient-reported outcomes Cognitive interviewing
This research project was supported by National Institutes of Health through the NIH Roadmap for Medical Research (Grant 5U01AR052171-03). Authors would like to express gratitude to the support provided throughout the study by Health Care for the Homeless Network, Public Health—Seattle & King County, and for help with recruitment provided by Seattle area shelters and homeless services programs. We also thank Mark Harniss, Ph.D. for article review and the research team for support with data collection and analysis, which included Kara Bogusz, Rana Salem, Leyla Khastou, Joe Skala, Erin Boespflug, Silvia Christian, and Selene Wu.
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