Barriers to Pain Management Among Rural Older Adults and Strategies to Address Them: Service Provider Perspective

Background and Purpose:

Pain control is essential to ensuring quality of life. However, certain sub-populations, such as older adults and rural residents, often lack optimal pain treatment. It is important to understand the barriers to pain management among older adults in rural communities and potential strategies to address them. However, research evidence is lacking on the topic. To address such a gap, the purpose of this study was to explore the views of healthcare service providers who are one of the major stakeholders on pain management and serve older rural residents in Alabama with limited income and resources.

Methods:

A qualitative research design was adopted to capture the common essence of participants’ experiences through a phenomenological method. Purposeful sampling and snowball sampling were used to recruit participants who meet the eligibility criteria: 1) 18 years old or older, 2) provides healthcare or related services to older adults experiencing pain and discomfort from chronic or serious illnesses and/or their caregivers, and 3) provides services to the residents of rural communities in Alabama. The PI of this study contacted potential participants who met the criteria as well as those recommended by other participants and deemed to be eligible for the study. A total of thirteen participants were recruited. A single-session, individual interview was conducted with each participant over the phone or Zoom. Each interview was audio-recorded and transcribed verbatim. Inductive, thematic analysis was used to identify repeated patterns and themes. Peer debriefing and audit trail were used to ensure the rigor of the study.

Results:

Our results revealed themes in four categories: 1) types of services provided: clinical assessment and treatment of pain, education on pain management and available resources, referral and linkage to resources, and caregiver support, 2) Impact of Covid-19: adjustment and changes in provided services, psychological burden on patients and caregivers, and limited access to services, 3) challenges in pain treatment: transportation (lack of public transportation/limited schedule/financial burden/rigid policy on transportation) and non-transportation related problems (lacking infrastructure and funding/low technology literacy/hesitance to seek pain treatment/insufficient knowledge about pain management/insufficient health insurance coverage), and 4) suggestions: transportation-related (more transportation options/financial assistance/accessible vehicles/political advocacy) and non-transportation-related support (improvement in infrastructure and funding/increase in non-pharmacological treatment options/intervention to address pain-related stigma and to promote pain education).

Conclusions and Implications:

Findings of this study provided an in-depth look into the service providers’ perspectives on challenges and suggestions for rural older adults’ pain management. Due to the remoteness of their rural communities and lack of many resources, the older adults served by the participants experience many transportation related difficulties to access optimal pain treatment and other related healthcare services. Therefore, it is critical for social work professionals to advocate for tailored interventions to improve transportation-related infrastructure and services in rural areas. In addition, social workers together with healthcare professionals should make a consorted, interdisciplinary efforts to promote essential pain management knowledge and provide alternative, non-pharmacological treatment options to improve rural older adults’ quality of life.