Using design thinking approaches to tailor a dyadic behavioral sleep intervention for persons living with dementia and their caregivers

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Project Summary Sleep disturbance is prevalent in persons living with mild cognitive impairment or early-stage Alzheimer’s disease and related dementias (PLwCI) as well as their caregivers. This prevalence suggests that sleep disturbance is an interdependent process that synergistically affects both members of the caregiving dyad. Sleep disturbance is associated with poorer health outcomes, including higher depressive symptoms and lower quality of life. Cognitive behavioral therapy for insomnia (CBTI) is effective for improving sleep disturbance in many populations, and support from a partner during CBTI results in more successful outcomes. The interdependence of PLwCI-caregiver sleep disturbance suggests the need for a dyadic intervention. However, there are no structured fully dyadic interventions focused on managing sleep disturbance in PLwCI and their caregivers; moreover, no dyadic interventions have been developed with input from these stakeholders. Aligned with the National Institute of Aging’s Behavioral and Social Science and Neuroscience high-priority dementia caregiver research agenda, the proposed K23 Patient-Oriented Mentored Career Development Award seeks to use design thinking, human-centered approaches within the CBTI framework to tailor a dyadic intervention (T-Dyadic Sleep) for PLwCI and their caregivers. Twenty PLwCI-caregiver dyads and 10 healthcare providers will be interviewed during the tailoring phase. We will then conduct a waitlist randomized control trial (N = 40 dyads) to test the acceptability, feasibility, and preliminary immediate and sustained efficacy (3 months) of T-Dyadic Sleep. The completion of this mentored research project will enable me to acquire foundational knowledge for conducting large-scale intervention trials and fulfill the need for effective dyadic interventions to treat sleep disturbance in PLwCI and caregiver dyads. The interdisciplinary training plan and goals developed for this K23 award will fill a critical gap in my current skill set. Building on my training as a clinician with expertise in sleep and dementia caregiving, I will develop proficiency in 1) design thinking approaches, 2) dyadic theories, concepts, and analytic methods, 3) identification and diagnosis of dementia- related disorders, including a focus on how these disorders relate to sleep disturbance, and 4) scientific writing, oral presentations, manuscript development, and peer review. I have assembled an excellent team of mentors (Drs. Hepburn, Barton, Lyons and Lah) and a collaborator (Dr. Gehrman). The K23 award will provide me with the necessary foundation to build a successful and independent program of research related to sleep, dementia, and caregiving. My program of research aligns well with NIA’s Strategic Directions for Research to understand and develop interventions to address the needs of patients living with Alzheimer’s disease and related dementias as well as the needs of their caregivers, and to engage persons living with dementia and their caregivers as part of research teams.