Developing, implementing, and evaluating a mixed-methods community-based participatory research sleep intervention in families with K-1st grade children living on the Blackfeet Indian Reservation

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Candidate: The overall goal of this K01 career development proposal is to provide me with the research and training needed to become a leader in the field of sleep intervention and health disparities research in American Indian (AI) populations. As my work has moved in to studying child sleep, it is clear that sleep intervention research is severely lacking. In addition, there are no studies that have been done in any AI community. My preliminary work on the Blackfeet reservation has shown that children do not get enough nightly sleep. These findings helped shape the direction for this K01 proposal to develop a novel sleep intervention grounded in cultural values to improve total sleep time (TST) in families that have children in the K-1st grade. The K01 research and training fulfills defined missions of the NHLBI by understanding sleep disparities and investigating factors that account for differences in a high risk, underserved AI community, and fostering the training of an AI investigator on a trajectory to becoming an independently funded researcher. My training will be targeted to two key areas (among others): 1) sleep and 2) training in mixed-methods research and randomized controlled trials with mentoring from local and national content experts. I will also enhance my understanding in two areas related to sleep: nutrition and stress/trauma. Developing and pilot-testing community-based sleep strategies grounded in AI cultural values, in combination with my training plan, will uniquely position me for a successful independent research career in sleep intervention research with underserved populations. Collectively, this K01 award will position me to develop an R01 proposal. Environment: The mentoring committee for this proposed K01 award is structured to support my research and training in sleep, nutrition, stress, mixed-methods research, accelerometry, and using social media for intervention delivery. Each mentor has extensive mentoring experience and content expertise in critical aspects of the research and training proposal. The Center for American Indian and Rural Health Equity (CAIRHE) has provided me with start-up funds, office laboratory space, IT support, statistical support, and 9 months of protected research time each year. In addition, Montana State University is committed to developing AI faculty and research with a number of institutes and centers that support health and biomedical research, including CAIRHE (NIH P20GM104417); the Montana IDeA Network of Biomedical Research Excellence, or INBRE (NIH P20GM103474); the American Indian/Alaska Native Clinical and Translational Research Program (NIH U54GM115371) among others. CAIRHE, where my office is located, provides an ideal environment for conducting community-based participatory research in tribal communities throughout Montana with resources, personnel, and expertise housed within the center. CAIRHE and other MSU research centers house several senior internal researchers with extensive NIH funding records including my primary mentor and CAIRHE director Dr. Adams. This optimal research environment will ensure that my transition into an independent health disparities scientist is successful. Research: Children sleep less now than ever before. Despite a growing body of literature in understanding child sleep patterns, sleep interventions are limited. To date, there are no sleep intervention studies that have been done in AI tribal communities. Elders and community members play a critical role in identifying culturally adaptive solutions to address problems in tribal communities. Because of the prevalence of historical trauma and mistrust of outsiders, I am uniquely positioned to do this work in my own tribal community. Preliminary data of sleep patterns showed that Blackfeet children age 2-5 and age 12-15 averaged 10.15 hours and 7.5 hours of weekday sleep. Despite this understanding, evidence-based solutions to increase TST in tribal communities are unknown. Thus, I propose to explore traditional sleep routines coupled with asking Blackfeet families about the current sleep environment in their home to develop a culturally specific sleep intervention with one child and one adult dyad. I hypothesize that the sleep intervention will increase TST (primary outcome) in the dyads. The intervention may also result in improved physical activity and diet, and decreased stress and screen time (secondary outcomes). Data will be measured at 0 and 9 weeks and then at 3 month follow-up. This hypothesis will be tested in the following specific aims: Specific Aim 1: Develop a culturally appropriate sleep intervention for Blackfeet families with K-1st grade children using surveys, focus groups, interviews, community input, and evidence-based strategies on sleep. Specific Aim 2: Feasibility test of the 9-week sleep intervention with K-1st grade Blackfeet families. The work proposed in these aims is designed to develop a comprehensive understanding of traditional sleep strategies and the child sleep environment to develop and pilot-test a novel culturally appropriate sleep intervention in the Blackfeet community. Developing culturally specific interventions to increase TST will address two significant gaps in the literature; understanding sleep problems in AI children and pilot-testing culturally adaptive sleep intervention strategies that will inform future research for investigators doing similar work in AI communities and provide direction for an R01 proposal that is one of the outcomes of this work.