A Qualitative Analysis of Multi-level Influences on Chronic Pain among Spanish-speaking Older Latino Adults in a Community Clinic in the United States

Spanish-speaking older Latino adults living with chronic musculoskeletal pain in the United States (US) experience worse pain outcomes than English-speaking and non-Latino older adults. This is partly because most pain interventions have been designed and tested primarily among English-speaking individuals. To address this, existing interventions for chronic musculoskeletal pain should be tailored to reflect the multilayered factors that impact and are impacted by chronic pain identified by Spanish-speaking older Latino adults. As such, we conducted three focus groups and five individual interviews (N = 16) with Spanish-speaking older Latino adults (≥ 55 years old). Focus groups and individual interviews were guided by a semi-structured script, audio-recorded, and later transcribed verbatim for qualitative coding. Informed by the socio-ecological model, data analysis followed a hybrid deductive-inductive approach to elucidate specific themes. Within the individual domain, pain co-occurred with complex medical needs and behavioral and psychological responses. In the interpersonal domain, participants described pushing through pain to meet family obligations, and how caregiving demands, relationship strain, and isolation worsened pain. In the structural domain, participants identified the presence of racial discrimination and the disproportionate burden of pain among Latinos, and physically demanding jobs shaping pain trajectories. Findings highlight the complex interplay of individual, interpersonal, community, cultural, and structural factors influencing pain outcomes. We discuss clinical and research implications to inform the cultural tailoring of interventions for Spanish-speaking older Latino adults living with chronic pain.