Testing a Strategy to Improve Diagnostic and Treatment Pathways for Children with Sleep-Disordered Breathing: the REPOSE Navigation Intervention - Obstructive sleep-disordered breathing (SDB), defined as nocturnal respiratory disturbances ranging from snoring to severe obstructive sleep apnea, affects 8.9 million (12%) children in the US. Black children are 4-6 times more likely to have SDB, but they are less likely to undergo evaluation and to receive timely standard of care treatments, such as tonsillectomy, to address SDB. Untreated SDB is associated with significant health consequences such as behavior disorders, poor academic performance, neurocognitive deficits, and cardiovascular problems. SDB care is complex and gaps in SDB diagnosis and management are pervasive. Currently, no effective method to address non-clinical barriers in SDB care has been established. A critical need exists for a multilevel, theory-based intervention to reduce barriers to care for children with SDB. Patient navigation is an evidence-based intervention that has shown to improve referral and adherence to treatment in a variety of health conditions and is a culturally acceptable intervention to promote access to care in the setting of uneven access to care. The candidate’s foundational work informed the development of a novel, multilevel theory-based patient navigation intervention, Reach for Equity in Pediatric Obstructive Sleep Evaluation (REPOSE). In the REPOSE intervention, a centralized patient navigator a) identifies and addresses dynamic individual barriers, b) provides resources and social support for parent-child dyads, and c) facilitates bidirectional SDB care coordination between clinical teams and parents to achieve evidence-based care. In this hybrid type I effectiveness implementation study, the candidate will conduct a pilot randomized controlled trial (RCT) in which N=80 parent-child dyads will be randomized to REPOSE or usual care for SDB. We will examine the extent to which the REPOSE intervention improves rates of adherence to evidence-based guidelines among children with SDB from a broad range of socioeconomic and rural/urban status (Aim 1) and changes in barrier resolution and self-efficacy among parents (Aim 2). In addition, we will evaluate barriers and facilitators to implementation as guided by the Consolidated Framework for Implementation Research (CFIR) with a focus on social determinants of health (Aim 3). The findings of this randomized pilot trial will inform the design of a future fully powered RCT. The overall objective of this K23 proposal is to support Dr. Phayvanh Pecha as she acquires the skills necessary to become an independent health disparities investigator with a program of research focused on improving access to care for children with SDB. The current proposal includes a comprehensive Training Plan that is supported by a team of experienced and successful mentors within a rich research training environment. The training and mentorship afforded by the K23 mechanism will ensure that the candidate achieves skills in clinical trial design, implementation science, and health disparities research. The candidate’s long-term career goal is to become an independent clinical investigator and leader in testing scalable interventions aimed at promoting healthcare access and improving outcomes for children with SDB.
