Tailored approach to sleep health education (TASHE): study protocol for a web-based randomized controlled trial
Williams et al. Trials
Tailored approach to sleep health education (TASHE): study protocol for a web-based randomized controlled trial
Natasha J. Williams 0
Rebecca Robbins 0
David Rapoport
John P. Allegrante
Alwyn Cohall
Gbenga Ogedgebe 0
Girardin Jean-Louis 0
0 Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, NYU Medical Center , New York, NY 10016 , USA
Background: Obstructive 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 Methods: This 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. Discussion: Few 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.
Adherence; Sleep health; Blacks; Continuous positive airway pressure; Health education; Health literacy; Internet; Obstructive sleep apnea
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Background
Increasingly, researchers and practitioners recognize that
obstructive sleep apnea (OSA) - one of the most
commonly diagnosed sleep disorders - disproportionately
affects blacks. One of the earliest studies documenting
racial/ethnic differences in the rate of OSA compared 225
black and 622 white volunteers, ages 2–86 years, and found
that 31% of blacks versus 10% of whites had OSA [1]. More
recent studies have also reported similar disparities
including adherence to OSA treatment, with blacks using positive
airway pressure (PAP) far less than their white
counterparts [2–4]. The underlying mechanisms of these
disparities are not clear. However, research suggests that the
disparities in OSA prevalence may be explained by genetic
factors and obesity [5], while disparities in treatment
adherence may be partially explained by socioeconomic
status [3] and sleep duration [2].
© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
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The Institute of Medicine and the National Institutes
of Health (NIH) recognize OSA as a chronic disease that
requires novel adherence strategies to promote enhanced
quality of life and diminish social and economic costs
[6]. Yet, our pilot data suggests that blacks tend to
underutilize sleep services. This is unfortunate given that
there may be a high prevalence of OSA in this
community, and that treatment is effective in improving
cardiovascular disease (CVD) risk factors, especially blood
pressure [7], which disproportionately burden blacks.
Insufficient sleep and sleep disorders
A recent analysis of data from 12 states conducted by the
Centers for Disease Control and Prevention (CDC)
illustrated that 35.3% of United States (US) adults reported
insufficient sleep and 37.9% reported unintentionally falling
asleep during the day [8]. It also appears that there is
increased awareness about sleep in the general population.
For example, using the National Ambulatory Medical
Care Survey, Ford et al. [9] found a 13% increase in the
number of physician office visits for sleep complaints and
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