Iterating the women in pain reduction and improved mood through empowerment intervention.

Purpose: To explain key adaptations made to a depression and pain intervention that addresses inequities in pain outcomes among older women. Design: The DAPPER (Depression and Pain Perseverance through Empowered Recovery) pilot study and the Women in PRIME (Pain Reduction and Improved Mood through Empowerment) study were randomized controlled trials using waitlist control designs. DAPPER focused on pain and depressive symptoms among middle-aged and older African American women who were pre-frail or frail, while Women in PRIME addressed similar symptoms among middle-aged and older women of all races living with physical disabilities. Methods: Ten DAPPER and eight Women in PRIME participants were interviewed post-intervention completion. Qualitative data for both studies was analyzed using a deductive qualitative content analysis approach. Quantitative data included descriptive statistics. Results: Seven changes were made from the DAPPER Study to the Women in PRIME Study. These changes included 1) Re-naming the intervention; 2) Adding retention practices; 3) Expanding to include women of all races; 4) Switching criterion of (pre)frailty to physical disability; 5) Adding group Acceptance & Commitment Therapy (ACT) sessions; 6) Reducing individual nurse visits from 8 to 5 visits; and 7) Switching from saliva to sweat patch for biomarker measurement. Conclusions: The changes made from DAPPER to Women in PRIME resulted in greater retention, participation in the intervention, and participation in the data collection timepoints. A critical component of equity-focused intervention iteration is ensuring that participant input and guidance directly shape the modifications and adaptations that advance the intervention toward larger scale trials.