Validating the HELP Survey to Understand Health Disparity Influence on Chronic Pain

Socioeconomic deprivation is shown to be linked to chronic lower back pain. However, a comprehensive approach to identify key components contributing to pain outcomes using a biopsychosocial model incorporating social determinants of health is needed to develop and tailor successful strategies for mitigating chronic pain development and persistence. We aimed to develop and validate an instrument (the HELP survey) to assess themes characterized by a combination of social determinants of health and the biopsychosocial model in an underserved population. The HELP survey was developed as part of an observational study determining the influence of health disparities on chronic pain interference, The Neighborhood of Pain: Health Disparity Influence on Level of Chronic Pain Interference study (HELP).

A multidisciplinary group of experts developed the 40-item, 5-domain HELP survey to address Pain Catastrophizing, Pain Motivation, Social Support, Health Care Access, and Physical Environment. After IRB approval, recruitment occurred at an academic pain clinic and emergency department. Survey validation included principal factor analysis, factor loadings of 0.40 or greater, and Cronbach's alpha of 0.70 or greater.

Initial pilot testing occurred in 48 participants, followed by question revision and retesting in 57 patients. The average age was 57 years old. The majority were female (61.9%), self-reported black (55.2%), and had a high school health literacy level of 60.9%. Nearly half of participants (52.4%) lived in a neighborhood of extreme socioeconomic disadvantage and for 43.4% highest educational attainment was high school. Pilot testing resulted in 5 domains with Cronbach's alphas: Pain Catastrophizing (0.82), Patient Motivation (0.80), Social Support (0.56), Health Care Access (0.75), and Physical Environment (0.81).

Pilot study validation of the HELP survey demographic data indicated testing was performed in an underserved chronic pain population, and questions supported measurement of social determinants of health and the biopsychosocial model based on the five themes identified.