COBRE Center for Sleep and Circadian Rhythms in Child and Adolescent Mental Health

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Project Summary Disrupted, insufficient sleep occurs in the majority of pregnant women and increases the risk of negative health consequences for mothers and their infants, including pregnancy and childbirth complications as well as chronic illnesses, such as major depression and weight retention/obesity. Conventionally, perinatal sleep dis- turbances have been viewed as expected and intractable, but recent studies demonstrate that behavioral inter- ventions are effective for improving sleep in pregnant and postpartum women. Nevertheless, efficient, scalable sleep interventions that are tailored to expectant and new mothers are scarce. This Administrative Supplement for Research on Women’s Health seeks to develop a high-fidelity, evidence-based sleep intervention in collab- oration with direct care workers who engage with perinatal women and to collect preliminary data regarding delivery of the resulting intervention to expectant and new parents. Our one-year pilot project is grounded in the RE-AIM framework, and will assess the Reach, Effectiveness, Adoption, Implementation, and Maintenance dimensions of this model to prepare for a large-scale future R01 hybrid effectiveness-implementation trial. In Phase 1, we will develop short, evidence-based, educational videos in English and Spanish that focus on im- proving perinatal sleep and that map onto modules in the free, publicly-available mobile app, CBTi Coach. Vid- eos will be produced and refined in cooperation with direct care workers and a video production company with community engagement experience. Direct care workers who work with perinatal women will then be trained to deliver the intervention (target n=35). In Phase 2, direct care workers will be invited to use the intervention with clients who report sleep problems and we will study implementation in workers and clients (target n=20). We will measure reach as the proportions of eligible workers who complete training and of eligible women who en- roll in the intervention. Effectiveness will be assessed in workers by examining feasibility and acceptability as well as sleep knowledge before and after the training. In perinatal women we will measure effectiveness with qualitative acceptability measures and change in insomnia severity index (ISI). Adoption will be defined as the number of community agencies/programs from which we draw direct care workers for training. We will evaluate implementation in direct care workers using qualitative data about their experiences with the intervention, i.e., expectations, barriers, facilitators, and plans for future use. Implementation measures in perinatal women will be quantitative (i.e., meta-data regarding video viewing, overall app use and use of specific app elements) and qualitative (perceptions of acceptability and utility). We will assess maintenance by examining rates of contin- ued enrollment of clients by direct care workers and rates of continued app use in perinatal women. This pro- ject will allow us to perfect our intervention in preparation for a future large-scale effectiveness-implementation trial of the integration of a powerful, free, behavioral sleep intervention into settings that serve women in high- risk populations including those with low socioeconomic status, families in rural areas, and military families.