S Megan Berthold1, Richard Feinn2, Angela Bermudez-Millan3, Thomas Buckley4, Orfeu M Buxton5, Sengly Kong6, Theanvy Kuoch6, Mary Scully6, Tu Anh Ngo7, Julie Wagner8,9. 1. University of Connecticut School of Social Work, Hartford, USA. 2. Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, USA. 3. Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, USA. 4. Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, USA. 5. Department of Biobehavioral Health, Pennsylvania State University, State College, USA. 6. Khmer Health Advocates, West Hartford, USA. 7. Edith Nourse Rogers Memorial VAMC, Bedford, USA. 8. Division of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, Farmington, USA. juwagner@uchc.edu. 9. Department of Psychiatry, University of Connecticut School of Dental Medicine, Farmington, USA. juwagner@uchc.edu.
Abstract
OBJECTIVES: Pain is common among torture survivors and refugees. Clear communication about one's pain is vital to timely and precise diagnosis and treatment but is rarely recognized as a social determinant of health. We examined whether self-reported difficulty communicating with their health care provider, along with standard social determinants, is associated with self-reported pain in Cambodian American refugees. METHODS: Secondary data analysis was conducted on n = 186 baseline assessments from a diabetes prevention trial of Cambodian Americans with depression. Bilingual, bicultural community health workers (CHWs) conducted surveys including social determinants of health and past week pain occurrence and interference. RESULTS: The sample was 78% female, modal household income = $25,000, mean age = 55 years, and mean education = 6.9 years. About one-third had private insurance and two-thirds could not speak English conversationally. The average pain score was 2.8 on a scale from 0-8 with 37% reporting no pain at all. In bivariate analyses, predictors of higher pain scores were higher difficulty understanding healthcare provider, depressive symptoms, trauma symptoms, food insecurity, and social isolation; predictors of lower pain scores were higher years of education, income, English language proficiency, social support, working, and having private insurance. In the multivariate backward elimination model only two predictors were retained: difficulty understanding healthcare provider and depressive symptoms. DISCUSSION: We propose that healthcare communication is a modifiable social determinant of health. Healthcare institutions should receive the resources necessary to secure patients' rights to clear communication including trained community health workers.
OBJECTIVES: Pain is common among torture survivors and refugees. Clear communication about one's pain is vital to timely and precise diagnosis and treatment but is rarely recognized as a social determinant of health. We examined whether self-reported difficulty communicating with their health care provider, along with standard social determinants, is associated with self-reported pain in Cambodian American refugees. METHODS: Secondary data analysis was conducted on n = 186 baseline assessments from a diabetes prevention trial of Cambodian Americans with depression. Bilingual, bicultural community health workers (CHWs) conducted surveys including social determinants of health and past week pain occurrence and interference. RESULTS: The sample was 78% female, modal household income = $25,000, mean age = 55 years, and mean education = 6.9 years. About one-third had private insurance and two-thirds could not speak English conversationally. The average pain score was 2.8 on a scale from 0-8 with 37% reporting no pain at all. In bivariate analyses, predictors of higher pain scores were higher difficulty understanding healthcare provider, depressive symptoms, trauma symptoms, food insecurity, and social isolation; predictors of lower pain scores were higher years of education, income, English language proficiency, social support, working, and having private insurance. In the multivariate backward elimination model only two predictors were retained: difficulty understanding healthcare provider and depressive symptoms. DISCUSSION: We propose that healthcare communication is a modifiable social determinant of health. Healthcare institutions should receive the resources necessary to secure patients' rights to clear communication including trained community health workers.
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