Implementing mindfulness practice to advance sleep health equity among Black women

实施正念练习以促进黑人女性的睡眠健康公平

• 批准号: 10831697
• 负责人: Soohyun Nam
• 金额: $ 50万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10831697
• 关键词: Implementing; mindfulness; practice; advance; sleep

Sleep deficiency, characterized by short sleep duration, poor sleep quality, and symptoms of insomnia, is a significant public health concern in the US. Insomnia is the most common sleep disorder but is generally undertreated. Black women have a high prevalence of clinically significant insomnia, which is associated with the risk for cardiometabolic disease and early mortality. However, there is a dearth of sleep interventions and implementation efforts for Black women. There is a growing interest in the influence of structural racism on downstream social and health inequalities, suggesting health disparities as “a special case of implementation failure.” The time lag between research discovery and uptake of evidence-based intervention is even more inflated in Black communities. The long-term goal of the proposed research is to achieve health- and healthcare equity by implementing an evidence-based, equity-focused sleep intervention to reduce stress and sleep deficiency-related cardiometabolic disease burden in Black communities. Mindfulness-based therapy for insomnia (MBTI) is an evidence-based stress management program using mindfulness meditation and behavioral therapy for insomnia. The efficacy of MBTI on stress reduction and sleep deficiency has been shown in multiple meta-analyses in the general population. Findings from our pilot MBTI study were also aligned with the evidence. Evaluating the effectiveness of MBTI and developing equity-focused implementation strategies that address social determinants of health (SDoH), unique to Black women, are urgently needed to achieve sleep health equity. To address gaps in implementation science, we propose a study guided by the NIMHD Research Framework and Equity-focused Implementation Research Framework through a community participatory approach. In phases 1 and 2, we will identify multi-level barriers and facilitators to implementing the online MBTI through an equity lens using community-engaged research with key stakeholders. Then, we will develop and refine equity-focused implementation strategies with the community advisory board, comprised of community- based organization members, African Methodist Episcopal Zion Church networks, clinicians, and community health workers (CHWs). In phase 3, we will use a Hybrid Type 1 effectiveness/implementation design with a pragmatic randomized controlled trial with MBTI and a waitlist control in Black women with insomnia. CHWs as SDoH specialists will assess and address social needs of Black women, and registered nurses will deliver the online MBTI intervention in the community settings. We will evaluate effectiveness- (insomnia severity reduction/ remission) and implementation (acceptability, feasibility, fidelity, cost, contextual factors, and sustainability) outcomes. The study will contribute to equity-focused implementation science and policy decisions by providing multi-level implementation determinants, equity-relevant metrics, and contextual factors through community- engaged research and evaluation of the outcomes.

睡眠不足，以睡眠时间短、睡眠质量差和失眠症状为特征，是一种 美国的重大公共卫生问题。失眠是最常见的睡眠障碍，但通常 没有得到充分的对待。黑人女性临床上严重失眠的患病率很高，这与 心脏代谢性疾病和早期死亡的风险。然而，缺乏睡眠干预和 为黑人妇女所做的执行工作。人们对结构性种族主义的影响越来越感兴趣 下游的社会和健康不平等，表明健康差距是“执行的特例” 失败了。“研究发现和采用循证干预之间的时间差距更大 在黑人社区被夸大了。这项拟议研究的长期目标是实现健康和医疗保健 通过实施以证据为基础、以公平为重点的睡眠干预来减少压力和睡眠 黑人社区缺乏相关心脏代谢性疾病的负担。基于正念的治疗方法 失眠(MBTI)是一种基于证据的压力管理计划，使用正念、冥想和 失眠的行为疗法。MBTI在减轻压力和睡眠不足方面的效果已被证明 在普通人群中进行了多项荟萃分析。我们的MBTI试点研究的结果也与 证据。评估MBTI的有效性并制定以股权为重点的实施战略 解决黑人女性特有的社会健康决定因素(SDoH)是实现睡眠的迫切需要 健康公平。为了解决实现科学方面的空白，我们建议进行一项由NIMHD Research指导的研究 通过社区参与的框架和以公平为重点的执行研究框架 接近。在第一阶段和第二阶段，我们将确定实施在线MBTI的多层次障碍和促进者 通过公平的视角，利用社区参与的研究，与关键利益攸关方合作。然后，我们将开发和 与社区咨询委员会一起完善以股权为重点的实施战略，该委员会由社区- 以组织成员、非洲卫理公会锡安教会网络、临床医生和社区为基础 卫生工作者(CHW)。在第3阶段，我们将使用混合类型1有效性/实施设计 在患有失眠的黑人妇女中使用MBTI和等待名单对照的务实随机对照试验。CHWs AS SDoH专家将评估和解决黑人妇女的社会需求，注册护士将提供 社区环境中的在线MBTI干预。我们将评估有效性-(失眠严重程度降低/ 缓解)和实施(可接受性、可行性、保真度、成本、背景因素和可持续性) 结果。这项研究将有助于以公平为重点的执行科学和政策决策，方法是 通过社区的多层次实施决定因素、与权益相关的指标和背景因素- 对结果进行研究和评估。