Tailored approach to sleep health education (TASHE): study protocol for a web-based randomized controlled trial

Abstract

BackgroundObstructive sleep apnea (OSA) is a sleep disorder that disproportionately affects African Americans (hereafter referred to as blacks). Moreover, blacks may underutilize sleep services including overnight polysomnography. Thus, OSA among blacks may go undiagnosed and untreated, which has significant health consequences, including hypertension, diabetes, cognitive impairment, and daytime sleepiness.Design and MethodsThis two-arm randomized controlled trial will assign 200 participants to a culturally and linguistically tailored web-based sleep educational platform. The website will be developed to ensure that the content is user friendly and that it is readable and acceptable by the target community. Participants will receive login information to a password-protected website and will have access to the website for 2 months. Study assessments will be collected at baseline, 2 months (post-enrollment) and at 6 months (follow-up). We will use qualitative and quantitative methods to develop tailored materials and to ascertain whether tailored materials will increase OSA knowledge and OSA health literacy by comparing blacks exposed to tailored materials versus those exposed to standard sleep health literature. We hypothesize that exposure to tailored OSA information will improve OSA health literacy.DiscussionFew studies have investigated the racial/ethnic disparities in relation to OSA screening and treatment comparing blacks and whites. Moreover, we know of no interventions designed to increase OSA knowledge and health literacy among blacks. Use of the Internet to disseminate health information is growing in this population. Thus, the Internet may be an effective means to increase OSA health literacy, thereby potentially increasing utilization of sleep-related services in this population.Trial registrationThe study is registered at clinicaltrials.gov, reference number NCT02507089. Registered on 21 July 2015.

<p>Are sleep patterns influenced by race/ethnicity – a marker of relative advantage or disadvantage? Evidence to date</p>

“…While culturally adapting interventions is a time-intensive process, using data from previous trials to explore differences in treatment for minorities and non-minorities while controlling for important factors such as SES, education, relationship status in the meanwhile, will be essential for determining how minorities fare with respect to established treatment guidelines. There is at least one meta-analysis of cultural adaptations of psychological interventions which found a large (g =0.67, p <0.001) overall effect size for adapted psychological interventions compared to no intervention or other interventions, and a medium effect size (g =0.52) for the adapted versus unadapted version of the same intervention 109. Notably, none of the adapted psychological interventions targeted sleep health.…”

“…Absent from the literature is the use of community-based principles in improving screening or treatment for sleep disorders. Principles of community-based approaches have a rich history in improving the uptake and adherence to important medical guidelines,113,114 and only when these trials are completed,109 will we be able to better assess to what extent can community-based approaches impact sleep health. Given that planning for Healthy People 2030 is underway, now more than ever, is it crucial to include these objectives with a particular focus on racial/ethnic minorities and from a social determinants of health perspective.…”

Socioeconomic Inequities in Adherence to Positive Airway Pressure Therapy in Population-Level Analysis

“…In conclusion, in a nationally representative population of patients with sleep apnea, socioeconomic inequities in PAP adherence persist despite Medicaid expansion. Considerations for change in health policy for individuals in lower income neighborhoods in addition to patient-level interventions aimed at promoting PAP adherence would be responsive to calls for promoting health equity in lower income populations [5,29,[37][38][39]. Moreover, we should exercise caution in implementing PAP adherence as a quality metric for healthcare practices or alternatively consider adjusting for the DSH index if PAP adherence were adopted as a quality metric.…”

Translational Sleep Science in Behavioral Medicine: Introduction to this Special Issue

“…As the pandemic experience has made clear, underserved groups are the least likely to receive adequate health care [ 35 ]. We are challenged with the need to tailor sleep promotion interventions to minority populations and to promote accessibility to health providers, most notably through internet access and the technologies to engage it.…”