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.
- 3.Pain Management: Reducing Disparities for Homeless Patients. (2004, October). Healing hands. Health Care for the Homeless Clinicians’ Network, National Health Care for the Homeless Council. Copy Editor, 8, 1–6. http://www.nhchc.org/Network/HealingHands/2004/Oct2004HealingHands.pdf. Accessed 5 Jan 2009.
- 4.National Health Care for the Homeless Council. (2002). A preliminary review of literature. Chronic medical illness and homeless individuals. Nashville, TN: Zerger S. http://www.nhchc.org/Publications/literaturereview_chronicillness.pdf. Accessed 5 Jan 2009.
- 5.National Health Care for the Homeless Council. (2007). Homelessness and health. Policy statements. http://www.nhchc.org/Advocacy/PolicyPapers/HomelessnessHealth2007.pdf. Accessed 5 Jan 2009.
- 8.DeNavas-Walt, C., Bernadette, P. D., & Cheryl, L. H. (2006). Income, poverty, and health insurance coverage in the US: 2005. US Census Bureau, Current Population Reports, P60-231, US Government Printing Office, Washington, DC: US http://www.census.gov/prod/2006pubs/p60-231.pdf. Accessed 5 Jan 2009.
- 11.Lehman, A. F., & Cordray, D. S. (1993). Prevalence of alcohol, drug, and mental disorders among the homeless: One more time. Contemporary Drug Problems, 20(3), 355–386.Google Scholar
- 14.Kilker, K. (2000). Considering health literacy. Issue Brief, Center of Medicare Education, 1(6), 1–8.Google Scholar
- 16.National Alliance to End Homelessness. (2009). Homelessness looms as potential outcome of recession. http://www.endhomelessness.org/content/article/detail/2161/.
- 17.National Alliance to End Homelessness. (2009). Homelessness counts: Changes in homelessness from 2005 to 2007. http://endhomelessness.org/content/article/detail/2158.
- 18.Merksey, H., & Bogduk, N. (Eds.). (1994). IASP task force in taxonomy. Pain terms: A current list with definitions and notes on usage. Classification of chronic pain syndromes and definitions of pain terms (2nd ed.). Seattle, WA: IASP Press.Google Scholar
- 24.Health Care for the Homeless Network Administrative Database. (2006). Public health Seattle & King County.Google Scholar
- 28.National Institute of Health. (1994). NIH guidelines on the inclusion of women and minorities as subjects in clinical research. NIH Guide, 23(11).Google Scholar
- 29.Thomson, G. E., Mitchell, F., & Williams, M., (Eds.). (2006). Committee on the review and assessment of the NIH’s strategic research plan and budget to reduce and ultimately eliminate health disparities. Examining the Health Disparities Research Plan of the National Institute of Health: Unfinished Business. Institute of Medicine.Google Scholar
- 30.Willis, G. B. (2005). Cognitive interviewing: A tool for improving questionnaire design. Thousand Oaks, CA: Sage Publications.Google Scholar
- 31.DeMaio, T. J., & Landreth, A. (2004). Do different cognitive interview techniques produce different results? In S. Presser, J. M. Rothgeb, M. P. Couper, et al. (Eds.), Methods for testing and evaluating survey questionnaires. Hoboken, NJ: John Wiley and Sons, INC.Google Scholar
- 33.Wilkinson, G. S. (1993). Wide range achievement test administration manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
- 36.Willis, G. B., & Lessler, J. T. (1999). Questionnaire appraisal system: QAS-99. Rockville, MD: Research Triangle Institute.Google Scholar
- 39.Amtmann, D., Ballard, R., Rothrock, N., Matter, R., Yorkston, K. M., & Lang, N. C. (2009). Cognitive interviewing to improve pain measurement for people with disabilities. (Unpublished work).Google Scholar
- 42.Paskett, E. D., Reeves, K. W., McLaughlin, J. M., Katz, M. L., McAlearney, A. S., Ruffin, M. T., et al. (2008). Recruitment of minority and underserved populations in the US: The centers for population health and health disparities experience. Contemporary Clinical Trials, 29, 847–861.PubMedCrossRefGoogle Scholar
- 43.Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Institute of Medicine. National Academy of Sciences. http://www.iom.edu/CMS/3740/4475.aspx Accessed 29 Dec 2008.