PROJECT SUMMARY/ABSTRACT Chronic musculoskeletal conditions and their primary source of pain, movement-evoked pain (MEP), causes significant pain interference, long-term mobility impairment, healthcare costs, and psychosocial inequalities for individuals, families, communities, and society-at-large. MEP affects more Black/African Americans (B/AAs) and is perceived as more severe. Compounded by race, age, and more disadvantageous social determinants of health (SDoH), this unequal burden of pain becomes even greater in health disparity populations, such as older B/AAs. Many B/AA older adults hesitate to use opioids and non-steroidal anti-inflammatory drugs long-term and rely on non-pharmacological pain self-management (SM) strategies. Current chronic musculoskeletal pain (CMP) SM interventions do not measure MEP as a primary endpoint nor address faith/spirituality, Black culture, and underlying potentially modifiable SDoH (e.g., health literacy, financial hardship), and therefore only offer small or no benefit over control groups. We propose to enhance older B/AAs’ capacity to manage MEP by investigating the effects of a socioculturally congruent pain SM intervention (Pain Relief for musculOskeletal conditions and Arthritis using Culturally-Tailored InterVentions for Black Elders [PROACTIVE]). This prototype intervention will provide culturally congruent pain SM education with a SM resource toolkit, active prayer, and financial counseling to explain participants’ healthcare benefits for pain care. This intervention moves beyond basic cultural tailoring and targets multiple areas for behavior change that are of importance to older B/AAs. We have assembled a demographically diverse, interdisciplinary, and clinically experienced team to lead this study. We will enroll 120 B/AAs (50 years and older) with CMP into a parallel group, single-blind, randomized controlled trial to test whether PROACTIVE decreases MEP in the immediate post-intervention period (n= 60) (Aim 1) and over time (Sub-Aim 1a) compared to a usual care control group (n= 60). To determine efficacy, we will use state- of-the-art and real-time technologies to measure primary outcome as well as pain interference, pain coping, and physical function (secondary outcomes) (Sub-Aim 1b). The PROACTIVE group will work with a faith-community nurse and financial counselor over four weeks to enhance knowledge of CMP SM, utilization of active prayer and faith, and financial literacy of health insurance benefits and resources available to cover treatments for pain. Each weekly session will last up to 2 hours and will be followed by six days of ecological momentary assessments of pain and SM outcomes and ecological momentary interventions guiding participants through weekly SM practice skills. A fourth booster session will reinforce content and training and help sustain SM. Also, we will examine the differential effects of PROACTIVE on MEP according to demographic (sex as a biological variable, gender,...