Department of Psychiatry and Behavioral Medicine, University of Alabama School of Medicine, Tuscaloosa Campus, P.O. Box 870326, Tuscaloosa, AL 35487-0326 USA.
Transl Behav Med. 2011 Jun;1(2):216-23. doi: 10.1007/s13142-011-0026-2.
Low literacy and chronic pain have been identified as significant problems in the rural USA. Cognitive behavioral therapy (CBT) is a widely used efficacious psychosocial treatment for chronic pain; adaptations for low-literacy rural populations are lacking. This paper reports on preparatory steps implemented to address this deficit. Adapting an existing group, CBT patient workbook for rural adults with low literacy is described, and adaptations to reduce cognitive demand inherent in CBT are explained via cognitive load theory. Adhering to health literacy guidelines, the patient workbook readability was lowered to the fifth grade. Two key informant interviews and four focus groups provided the impetus for structural and procedural adaptations. Using health literacy guidelines and participant feedback, the patient workbook and treatment approach were adapted for implementation in low-literacy rural adult chronic pain populations, setting the stage for proceeding with a larger trial using the adapted materials.
在美农村地区，文化程度低和慢性疼痛是两个严重的问题。认知行为疗法（CBT）是一种广泛应用于慢性疼痛的有效心理社会治疗方法；但针对文化程度低的农村人群的适应性措施还很缺乏。本文报告了为解决这一不足而采取的预备步骤。本文描述了为文化程度低的农村成年人改编现有的 CBT 团体患者手册，并通过认知负荷理论解释了降低 CBT 内在认知需求的适应措施。该患者手册遵循健康素养准则，将可读性降低到五年级水平。两次关键知情人访谈和四次焦点小组为结构性和程序性适应提供了动力。使用健康素养准则和参与者的反馈，对患者手册和治疗方法进行了改编，以便在文化程度低的农村成年慢性疼痛人群中实施，为使用改编后的材料进行更大规模的试验奠定了基础。
