Reducing Health Disparities for Black Women in the Treatment of Insomnia
Condition: Insomnia
MeSH terms: Sleep Initiation and Maintenance Disorders
Study type: Interventional

Summary: 
      Black women are at a higher risk of developing insomnia than other women and insomnia has
      profound adverse physical and psychological health consequences. There is an
      internet-delivered treatment program for insomnia that has been shown to be effective in
      White individuals but there is little evidence of the effectiveness of this treatment among
      Black women. The goal of this study is to conduct a comparative effectiveness trial of three
      online insomnia therapies after a 6 month follow-up period--a cognitive behavioral therapy
      for insomnia (CBT-I) called SHUTi (Sleep Healthy Using the Internet), SHUTi modified for
      Black women (SHUTi-BWHS), and patient education (PE) (usual treatment). This study aims to
      provide the much needed evidence to help Black women make informed decisions regarding
      treatment for their insomnia.
    

Detailed description: 
      Eligible Black Women's Health Study (BWHS) participants who completed the Insomnia Severity
      Index(ISI) on the 2015 BWHS questionnaire with a score compatible with insomnia disorder will
      be randomly selected to receive information that will inform them of the opportunity to
      participate in a free program designed to address their sleep problems. They will then be
      directed to an Insomnia Study Website which will provide information about the study and
      directions on how to complete an online screening questionnaire for those interested in
      participating. Reminders will be sent to these selected women to encourage participation.

      Once interested women submit the screening questionnaire, an internal assessment will be
      carried out to see if potential participants are eligible. Those determined to be ineligible
      will be sent a thank you letter and informed that they were not selected for this trial.
      Those who meet the qualifications for the study will be directed to the informed consent form
      with a note indicating that a member of the study team will call them within several days at
      a time they indicated would be convenient for them. The study team member will then call each
      eligible subject and review with her, over the phone, each section of the consent form. A
      verbal acknowledgement of consent, or non-consent, will be recorded in the study database.

      Once women have been verbally consented, they will be instructed on the use of the web
      programs and, completion of online sleep logs. Privacy concerns will be addressed.
      Pre-intervention, post-intervention, and 6-month assessment questionnaires, including the
      Insomnia Severity Index (ISI) will be administered pre-intervention (Time 1),
      post-intervention 9 weeks after Time 1 (Time 2), and 6 months later (Time 3). After the
      pre-intervention questionnaires and sleep logs are completed, participants will be informed
      of their treatment which was selected at random from the three online treatments: SHUTi
      -BWHS, SHUTi, and patient education (PE) (also called sleep hygiene or sleep information).
      The PE group will use a website that discusses ways to improve behaviors and environments
      that can affect sleep. This material is also included in the other 2 treatments but is
      presented in a different way. Participants using the PE website may log in as often as they
      like for as long as they like. Participants randomized to SHUTi-BWHS or SHUTi will use a web
      program that has six modules called Cores. Participants will log in to the six modules of
      their assigned treatment program over an 8-week period. Cores are completed one at a time in
      order. Each Core is expected to take 45 to 60 minutes to complete. Each Core contains
      information and exercises designed to help change behaviors and thoughts that can contribute
      to sleep problems.

      Nine weeks after completing the initial pre-intervention questionnaire, all participants will
      be asked to complete another questionnaire about their sleep and health, which includes the
      ISI, and also to complete 10 sleep diaries. Six months later, participants will be asked
      again to complete a questionnaire that includes the ISI, followed by completion of 10 sleep
      diaries.
    

Intervention name(s): SHUTi; modified SHUTi (i.e., SHUTi-BWHS); Patient education
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): A woman assigned to SHUTi receives access to an online program that includes 6 interactive sessions that are designed to be reviewed over a period of about 8 weeks. The online sessions include videos and written material that give information about factors that affect sleep, changes that might help sleep patterns, and how to make those changes. Each session takes about 45 to 60 minutes to complete. During and between sessions, the participant fills out sleep diaries to gather information about daily sleep patterns. At 3 different times, the woman is asked to fill out questionnaires about her sleep and health as well as sleep diaries. Time 1 is just before starting the first session of the SHUTi program. Time 2 is about 9 weeks later and Time 3 is about six months after that. The questionnaires will be used to assess the effect of the online program on the participant's sleep and health.; A woman assigned to modified SHUTi (i.e., to SHUTi-BWHS) receives access to an online program that includes 6 interactive sessions that are designed to be reviewed over a period of about 8 weeks. The online sessions include videos and written material that give information about factors that affect sleep, changes that might help sleep patterns, and how to make those changes. Each session takes about 45 to 60 minutes to complete. During and between sessions, the participant fills out sleep diaries to gather information about daily sleep patterns. At 3 different times, the woman is asked to fill out questionnaires about her sleep and health as well as sleep diaries. Time 1 is just before starting the first session of the modified SHUTi program. Time 2 is about 9 weeks later and Time 3 is about six months after that. The questionnaires will be used to assess the effect of the online program on the participant's sleep and health.; A woman assigned to patient education receives access to a website that provides detailed information on habits and environments that may help or hinder sleep. The site can be visited as often as desired. At 3 different times, the woman is asked to fill out questionnaires about her sleep and health, as well as sleep diaries to gather information about her daily sleep pattern. Time 1 is just before first logging into the sleep information website. Time 2 is about 9 weeks later and Time 3 is six months after that. The questionnaires will be used to assess the effect of the sleep information program on the participant's sleep and health.
Other intervention name(s): web-based cognitive-behavioral therapy for insomnia (CBT-I); web-based CBT-I tailored for Black women; sleep hygiene
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Eligible subjects will be randomly assigned to one of the 3 intervention groups; SHUTi-BWHS, SHUTi, or patient education (PE).
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Patient education; Sleep hygiene; Sleep Healthy Using the Internet (SHUTi); Cognitive-behavioral therapy (CBT); Black Women's Health Study