Empowering Self-Management for Chronic Low Back Pain: A Human-Centered Design Study of Spanish- and Cantonese-Preferring Patients in the United States.

Introduction: Chronic low back pain (cLBP) is a leading cause of disability with disproportionately high impacts on marginalized populations, including non-English-preferring patients. These patients face significant barriers to accessing care and adhering to self-management strategies due to language barriers, socioeconomic challenges, and cultural differences. Despite the emphasis on self-management for cLBP, limited research has focused on understanding the specific needs and preferences of Spanish- and Cantonese-preferring patients. Objective: This study aimed to explore the self-management priorities of Spanish- and Cantonese-preferring patients with cLBP. Using a human-centered design approach, we sought to identify patient preferences for self-management support materials and strategies that could be tailored to their unique needs. Design: Qualitative research using thematic analysis of focus groups conducted in participants' preferred language. Setting: Urban, academic-affiliated county hospital between March and May 2024. Patients: Spanish- and Cantonese-preferring patients with cLBP. Interventions: Not applicable. Main outcome: Key themes in participants' experiences with cLBP care, barriers to self-management, and preferences for educational materials. Results: Fifteen patients participated across six focus groups (three focus group in each language). Four primary themes emerged from the focus groups: (1) the need for empathic, tailored educational supports that fit into patients' lives, (2) a desire for self-management plans that account for social and economic constraints, (3) recognition of mental health and social isolation as factors that influence cLBP experience, and (4) a need for clearer guidance on self-management strategies and trustworthy resources. Both Spanish- and Cantonese-preferring participants expressed a preference for video-based resources, plain-language materials, and support for understanding the causes and management of their pain. Conclusion: 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 minoritized populations. Human-centered design offers a promising approach to reducing disparities in cLBP outcomes by creating patient-driven solutions that prioritize empathy, practicality, and cultural relevance.