Empowering Self-Management of Chronic Low Back Pain Among Spanish and Cantonese Speakers in the United States.

BACKGROUND

Chronic low back pain (cLBP) is a major cause of disability worldwide and disproportionately affects patients with limited English proficiency (LEP) who face linguistic, cultural, and socioeconomic barriers to care. Spanish- and Cantonese-preferring populations in the U.S. often struggle with limited access to culturally appropriate resources, highlighting the need for patient-centered approaches.

METHODS

We conducted a qualitative study at an urban, academic-affiliated county hospital between January and June 2024. Focus groups were facilitated by bilingual, bicultural researchers. The study objective was to explore the priorities, barriers, and self-management preferences of Spanish- and Cantonese-preferring patients with the human-centered design (HCD) approach. Transcripts were translated, reviewed, and analyzed inductively to identify key themes. Institutional Review Board (IRB) approval to interview fifteen participants was obtained prior to study initiation.

RESULTS

Fifteen Spanish- and Cantonese-preferring patients with cLBP participated in six focus groups. Participants reported 6.82 on the numerical rating scale of pain (NRS) (SD 2.49), with 71% of Spanish-speaking and 78% of Cantonese-speaking participants reporting 10/10 "complete trust" in their healthcare providers. Thematic analysis revealed four key themes: the need for empathic, tailored educational supports; desire for plans that reflect social and economic realities; recognition of mental health and social isolation as contributors to pain; and a need for clearer, trustworthy guidance on self-management. Participants preferred plain-language, video-based resources and support in understanding cLBP causes and management. Across both groups, patients expressed confusion about trustworthy information sources and called for clinician-vetted guidance and clearer explanations of self-management strategies.

CONCLUSIONS

Spanish- and Cantonese-preferring patients with cLBP face significant barriers to self-management and would benefit from culturally and linguistically appropriate resources. This study highlights the need for healthcare systems to develop and deliver tailored, accessible self-management support materials that address the unique challenges faced by patients with LEP.