Implementing mindfulness practice to advance sleep health equity among Black women - Sleep deficiency, characterized by short sleep duration, poor sleep quality, and symptoms of insomnia, is a
significant public health concern in the US. Insomnia is the most common sleep disorder but is generally
undertreated. Black women have a high prevalence of clinically significant insomnia, which is associated with
the risk for cardiometabolic disease and early mortality. However, there is a dearth of sleep interventions and
implementation efforts for Black women. There is a growing interest in the influence of structural racism on
downstream social and health inequalities, suggesting health disparities as “a special case of implementation
failure.” The time lag between research discovery and uptake of evidence-based intervention is even more
inflated in Black communities. The long-term goal of the proposed research is to achieve health- and healthcare
equity by implementing an evidence-based, equity-focused sleep intervention to reduce stress and sleep
deficiency-related cardiometabolic disease burden in Black communities. Mindfulness-based therapy for
insomnia (MBTI) is an evidence-based stress management program using mindfulness meditation and
behavioral therapy for insomnia. The efficacy of MBTI on stress reduction and sleep deficiency has been shown
in multiple meta-analyses in the general population. Findings from our pilot MBTI study were also aligned with
the evidence. Evaluating the effectiveness of MBTI and developing equity-focused implementation strategies
that address social determinants of health (SDoH), unique to Black women, are urgently needed to achieve sleep
health equity. To address gaps in implementation science, we propose a study guided by the NIMHD Research
Framework and Equity-focused Implementation Research Framework through a community participatory
approach. In phases 1 and 2, we will identify multi-level barriers and facilitators to implementing the online MBTI
through an equity lens using community-engaged research with key stakeholders. Then, we will develop and
refine equity-focused implementation strategies with the community advisory board, comprised of community-
based organization members, African Methodist Episcopal Zion Church networks, clinicians, and community
health workers (CHWs). In phase 3, we will use a Hybrid Type 1 effectiveness/implementation design with a
pragmatic randomized controlled trial with MBTI and a waitlist control in Black women with insomnia. CHWs as
SDoH specialists will assess and address social needs of Black women, and registered nurses will deliver the
online MBTI intervention in the community settings. We will evaluate effectiveness- (insomnia severity reduction/
remission) and implementation (acceptability, feasibility, fidelity, cost, contextual factors, and sustainability)
outcomes. The study will contribute to equity-focused implementation science and policy decisions by providing
multi-level implementation determinants, equity-relevant metrics, and contextual factors through community-
engaged research and evaluation of the outcomes.