Assessing Clinical Effectiveness and Implementation of Worksite Sleep Health Coaching in Firefighters

背景资料。心脏事件是消防员死亡的主要原因，发生在 高得惊人的比率。睡眠不足是心血管疾病(CVD)的一个主要的、可改变的风险因素， 高达40%的消防员经历了严重的睡眠中断，从而筛查出睡眠阳性 精神错乱。认知行为疗法是治疗失眠的有效方法。 在医疗保健环境中。然而，CBTI告知睡眠健康指导和睡眠的有效性 工作场所的健康促进，特别是消防员的健康促进，在很大程度上是未知的。理论驱动 需要进行研究来解决这一研究与实践之间的差距，并确定促进者和障碍 在这一高危人群中实施干预。 进球了。这项提议的主要目标是检查可扩展的、CBTI知情的干预措施， 消防员睡眠健康指导(FfSHC)，当在现实世界中实施时，改善睡眠干扰 有需求的工作环境。 方法：研究方法。本研究建议进行阶梯式楔形整群随机对照试验，以 检查对400名职业生涯实施的循证睡眠健康指导干预的有效性 20个消防部门的消防员(目标1)。主要结果是(A)语用提示睡眠 干扰问卷和(B)由活动描记得出的多维睡眠健康指数。 二级和三级结果包括：睡眠相关损害、睡眠连续性、血压、心脏 以及对胆固醇、体重指数和血压的长期临床评估。晋级 实施科学，该项目将采用研究实施的综合促进行动 在卫生服务(IPARIHS)框架指导混合方法形成性评价(目标2a) 干预适应和实施战略。以理论为基础的过程评估(目标2b)是 嵌入临床试验，探索促进机构级实施的因素组合 并为未来在公共安全环境中的实施研究提供信息。 意义和创新。这项研究将加速睡眠健康干预向 通过应用IPARIHS框架，促进工作场所健康和推进实施科学。 睡眠健康教练的使用是创新的，并为项目如何扩大覆盖范围以解决 睡眠不足的全球性问题。这项研究的长期目标是提供关键知识， 促进睡眠健康干预措施的广泛实施、传播和持续利用 促进持续充足的睡眠，并最终降低心血管疾病的风险。学习目标的实现将提高学习成绩 消防员的健康和健康，他们的健康对确保公共安全和支持至关重要 社区复原力。

Background. Cardiac events are the leading cause of death among firefighters and occur while on-duty at an alarmingly high rate. Short, disrupted sleep is a major, modifiable risk factor for cardiovascular disease (CVD), and up to 40% of firefighters experience sufficiently severe sleep disruption to screen positive for sleep disorders. Cognitive behavioral therapy for insomnia (CBTi) is well-established as efficacious and effective within health care settings. However, the effectiveness of CBTi-informed sleep health coaching and sleep health promotion in workplace settings, and among firefighters specifically, is largely unknown. Theory-driven research is required to address this research-to-practice gap and also identify facilitators to and barriers of intervention implementation in this high-risk population. Goal. The primary objective of this proposal is to examine whether a scalable, CBTi-informed intervention, firefighter sleep health coaching (ffSHC), improves sleep disturbances when implemented in a real-world, high- demand work environment. Methods. This study proposes to conduct a stepped wedge cluster randomized controlled trial in order to examine the effectiveness of an evidence-based sleep health coaching intervention delivered to 400 career firefighters across 20 fire departments (Aim 1). The primary outcomes are (a) the pragmatic PROMIS Sleep Disturbances questionnaire and (b) the multidimensional sleep health index derived from actigraphy. Secondary and tertiary outcomes include: sleep related impairment, sleep continuity, blood pressure, heart rate, and long-term clinic-assessments of cholesterol, body mass index, and blood pressure. To advance implementation science, this project will employ the Integrated Promotion Action on Research Implementation in Health Services (iPARIHS) framework to guide a mixed methods formative evaluation (Aim 2a) of intervention adaptations and implementation strategies. A theory-based process evaluation (Aim 2b) is embedded within the clinical trial to explore combinations of factors that promote agency-level implementation and to inform future implementation research in public safety settings. Significance and Innovation. This research will accelerate the translation of sleep health intervention to workplace wellness and advance implementation science through the application of the iPARIHS framework. The use of sleep health coaches is innovative and models how programs may expand reach to address the global problem of insufficient sleep. The long-term goal of this research is to provide critical knowledge that facilitates the widespread implementation, dissemination, and sustained utilization of sleep health intervention to promote continuous, sufficient sleep and ultimately mitigate CVD risk. Achievement of study goals will improve the health and wellness of firefighters, a population whose health is vital to assuring public safety and supporting community resiliency.