Implementing mindfulness practice to advance sleep health equity among Black women

睡眠不足是一种以睡眠时间短、睡眠质量差和失眠症状为特征的 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 治疗不足黑人女性有很高的临床意义上的失眠患病率，这与 心脏代谢疾病和早期死亡的风险。然而，缺乏睡眠干预， 为黑人妇女开展工作。人们越来越关注结构性种族主义对 下游的社会和健康不平等，建议健康差距作为“一个特殊的实施情况， 失败。”研究发现和接受循证干预之间的时间差甚至更大。 在黑人社区里，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的、以公平为重点的睡眠干预来减少压力和睡眠， 在黑人社区中缺乏相关的心脏代谢疾病负担。正念疗法 失眠症（MBTI）是一种基于证据的压力管理计划，使用正念冥想， 失眠症的行为疗法MBTI在减轻压力和睡眠不足方面的疗效已经显示出来 在一般人群中的多个荟萃分析中。我们的MBTI试点研究结果也与 证据的评估MBTI的有效性并制定以公平为重点的实施战略 解决健康的社会决定因素（SDoH），独特的黑人妇女，迫切需要实现睡眠 健康公平。为了解决实施科学的差距，我们提出了一项由NIMHD研究指导的研究。 通过社区参与的框架和以公平为重点的实施研究框架 approach.在第一和第二阶段，我们将确定实施在线MBTI的多层次障碍和促进因素 通过公平透镜，利用社区参与的研究与关键利益攸关方。然后，我们将开发和 与社区咨询委员会一起完善以公平为重点的执行战略，该委员会由社区- 基于组织成员，非洲卫理公会锡安教会网络，临床医生和社区 卫生工作者。在第3阶段，我们将使用混合类型1有效性/实施设计， 在黑人女性失眠患者中进行MBTI和等待名单对照的实用随机对照试验。CHW作为 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、忠诚度、成本、背景因素和可持续性） 结果。这项研究将通过提供以下信息，促进注重公平的执行科学和决策 多层次的实施决定因素，公平相关的指标，以及通过社区的背景因素， 参与研究并评估结果。

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.