The Complementary Health Approaches for Pain Survey (CHAPS): Validity testing and characteristics of a rural population with pain

ObjectivesLittle is known about patterns and correlates of Complementary Health Approaches (CHAs) in chronic pain populations, particularly in rural, underserved communities. This article details the development and implementation of a new survey instrument designed to address this gap, the Complementary Health Approaches for Pain Survey (CHAPS).DesignFollowing pilot-testing using pre-specified criteria to assess quality and comprehension in our target population, and after feedback regarding face-validity from content experts and stakeholders, the final cross-sectional self-report survey required 10–12 minutes to complete. It contained 69 demographic, lifestyle and health-related factors, and utilized a Transtheoretical Model (TTM) underpinning to assess short- and long-term use of 12 CHAs for pain management. Twenty additional items on pain severity, feelings, clinical outcomes, and activities were assessed using the Short-Form Global Pain Scale (SF-GPS); Internal reliability was assessed using Cronbach’s alpha.Settings/locationInvestigators conducted consecutive sampling in four West Virginia pain management and rheumatology practices.Participants301 Appalachian adult patients seeking conventional care for pain management.ResultsResponse rates were high (88% ± 4.1%). High quality and comprehension deemed the CHAPS an appropriate measurement tool in a rural population with pain. Missing data were unrelated to patient characteristics. Participants predominantly experienced chronic pain (93%), had five or more health conditions (56%, Mean = 5.4±3.1), were white (92%), female (57%), and middle-aged (Mean = 55.6 (SD = 13.6) years). Over 40% were disabled (43%) and/or obese (44%, Mean BMI = 33.4±31.5). Additionally, 44% used opioids, 31% used other prescription medications, and 66% used at least one CHA for pain, with 48% using CHAs for greater than 6 months. There was high internal reliability of the SF-GPS (alpha = .93) and satisfactory internal reliability for each of the five TTM stages across (all) twelve CHAs: precontemplation (0.89), contemplation (0.72), preparation (0.75), action (0.70), and maintenance (0.70).ConclusionsThe CHAPS is the first comprehensive measurement tool to assess CHA use specifically for pain management. Ease of administration in a population with pain support further use in population- and clinic-based studies in similar populations.研究背景：慢性疼痛人群，尤其是农村医疗资源匮乏社区的慢性疼痛人群，其补充医疗方法（Complementary Health Approaches, CHAs）的使用模式与相关影响因素目前仍鲜为人知。本文详细介绍了专为填补这一研究空白而开发的新型调查工具——疼痛管理补充医疗方法调查问卷（Complementary Health Approaches for Pain Survey, CHAPS）的研制与实施流程。 研究设计：首先按照预设标准在目标人群中开展预试验，以评估工具的质量与可理解性；同时收集内容专家与利益相关方对其表面效度的反馈意见。最终定稿的横断面自填式调查问卷完成作答仅需10至12分钟，涵盖69项人口统计学、生活方式及健康相关变量。该工具以跨理论模型（Transtheoretical Model, TTM）为理论框架，用于评估12种补充医疗方法用于疼痛管理的短期与长期使用情况。此外，研究采用简易整体疼痛量表（Short-Form Global Pain Scale, SF-GPS）对疼痛严重程度、情绪感受、临床转归及日常活动相关的20项附加条目进行评估；内部信度则通过克朗巴赫α系数（Cronbach’s alpha）进行检验。 研究场景与地点：研究人员在西弗吉尼亚州的四家疼痛管理与风湿病诊疗机构开展连续抽样。 研究对象：共纳入301名阿巴拉契亚地区成年疼痛患者，均因疼痛管理寻求常规医疗服务。 研究结果：问卷应答率较高（88% ± 4.1%）。经评估，CHAPS在农村疼痛人群中具备良好的质量与可理解性，适合作为该人群的测量工具。缺失数据与患者基线特征无相关性。研究对象中绝大多数存在慢性疼痛（93%），合并5种及以上健康问题者占比56%（平均合并症数=5.4±3.1），种族以白人为主（92%），女性占比57%，平均年龄为55.6岁（标准差=13.6）。超过40%的受试者存在残疾（43%）或肥胖（44%，平均BMI=33.4±31.5）。此外，44%的受试者使用阿片类药物，31%使用其他处方药物，66%至少使用过1种补充医疗方法进行疼痛管理，其中48%的使用者持续使用时长超过6个月。简易整体疼痛量表（SF-GPS）的内部一致性信度极佳（α=0.93）；针对12种补充医疗方法的5个跨理论模型阶段，其内部一致性信度均处于可接受水平：前意向阶段为0.89，意向阶段为0.72，准备阶段为0.75，行动阶段为0.70，维持阶段为0.70。 研究结论：CHAPS是首款专门针对疼痛管理场景评估补充医疗方法使用情况的综合性测量工具。该工具在疼痛人群中施测便捷，支持在相似人群的人群水平与临床场景研究中进一步推广应用。