Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, 221 Longwood Ave, BLI 225, Boston, Massachusetts, USA, 02115.
Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, Massachusetts, USA, 02215; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA, 02115.
Sleep Health. 2020 Apr;6(2):205-213. doi: 10.1016/j.sleh.2019.12.009. Epub 2020 Jan 23.
Despite the high prevalence of inadequate sleep in racially/ethnically diverse, low-income adults, there is scant research targeting sleep health interventions among underserved populations. Sleep hygiene (SH) recommendations may help promote sleep health for the general population; however, they likely require tailoring to optimize uptake and effectiveness in the "real world" given socio-contextual factors. As an initial step to developing contextually appropriate and effective community-based SH interventions, we conducted qualitative research to understand SH behaviors, beliefs, and barriers in a low-income, ethnically diverse sample of adults.
We recruited 24 racially/ethnically diverse adults from an affordable housing community who self-reported sleeping ≤6 hours on average. Participants were invited to either an individual interview (n = 5) or a focus group (n = 3). A deductive, thematic-analysis approach was employed. Data collection and interpretation were informed by the Socio-Contextual Model of Behavior Change.
There was evidence of high acceptability of SH and interest in improving sleep health. Barriers to implementing SH were multifaceted, including individual (knowledge, motivation, habits, medical issues, stress, trauma), interpersonal (caregiving), organizational (job strain), and environmental (noise) factors.
Future strategies for adapting behavioral SH interventions should target knowledge, skill development, and behavioral change domains, such as motivation, social support, and self-efficacy. In addition, adapting SH beyond the clinical context for a high-need community population requires attention to multilevel sociocontextual factors that contribute to sleep health, particularly chronic stress, prior trauma, and adverse sleeping environments. Development of novel trauma-informed SH interventions may promote effective and safe implementation.
尽管不同种族/族裔、低收入的成年人普遍存在睡眠不足的问题，但针对服务不足人群的睡眠健康干预措施的研究却很少。睡眠卫生（SH）建议可能有助于促进普通人群的睡眠健康；然而，鉴于社会文化因素，它们可能需要进行调整，以优化在“真实世界”中的接受度和效果。作为制定基于社区的具有文化敏感性和有效的 SH 干预措施的初始步骤，我们开展了定性研究，以了解低收入、种族/族裔多样化的成年人中的 SH 行为、信念和障碍。
我们从一个经济适用房社区招募了 24 名自我报告平均睡眠时间≤6 小时的不同种族/族裔的成年人。邀请参与者参加个人访谈（n=5）或焦点小组（n=3）。采用演绎主题分析方法。数据的收集和解释受行为变化的社会文化模型的指导。
SH 具有高度的可接受性，且参与者对改善睡眠健康有兴趣。实施 SH 的障碍是多方面的，包括个人因素（知识、动机、习惯、医疗问题、压力、创伤）、人际因素（照顾）、组织因素（工作压力）和环境因素（噪音）。
未来适应行为 SH 干预措施的策略应针对知识、技能发展和行为改变领域，如动机、社会支持和自我效能。此外，为满足高需求社区人群的需求，需要关注多层面的社会文化因素，这些因素会影响睡眠健康，特别是慢性压力、先前的创伤和不良的睡眠环境。开发新的创伤知情 SH 干预措施可能会促进有效和安全的实施。
