Background 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 at an urban, academic-affiliated county hospital. 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.

Methods We conducted six focus groups (three each for Spanish- and Cantonese-preferring participants) between March and May 2024, involving 27 patients with cLBP. Patients were recruited from an urban safety-net hospital, and focus groups were conducted in participants’ preferred language. Participants discussed their experiences with cLBP care, barriers to self-management, and their preferences for educational materials. Data were analyzed using an inductive coding approach to identify key themes.

Results Four primary themes emerged from the focus groups: (1) the need for empathic, tailored educational supports that fit into patients’ lives, (2) the desire for self-management plans that account for social and economic constraints, (3) the recognition of mental health and social isolation as critical aspects of cLBP care, 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, but are motivated to engage in self-care if provided with 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 these 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.

chronic low back painself-managementdisparitieshuman-centered designSpanish-speakingCantonese-speakinghealthcare accesspatient-centered careCompeting Interest Statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; JL owns shares of Bioniks, LLC (a company commercializing a depth camera system similar to that being used by the REACH Physical Function and Biomechanics Core), is an Officer for Bioniks and serves on the Board of Directors; JL owns shares of Aclarion and is a consultant for Aclarion (a company which has developed and is marketing the magnetic resonance spectroscopy (MRS) diagnostic tool that is being used for the REACH comeBACK patient cohort); CO owns options of Aclarion; and JB owns options of Bioniks.

Funding Statement

Research reported in this publication was supported by the National Institute Of Arthritis And Musculoskeletal And Skin Diseases of the National Institutes of Health under Award Number U19AR076737. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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