Developing a culturally tailored digital health intervention for insomnia in Black women

Insomnia disorder is highly prevalent among Black women. Cognitive-behavioral therapy for insomnia (CBT-I) is considered the optimal treatment, but very little efficacy research has been conducted in minority populations. Culturally tailoring intervention content may increase participant engagement and improve treatment outcomes. We culturally tailored an Internet-delivered CBT-I program (Sleep Healthy Using the Internet; SHUTi) for Black women. First, relevant stakeholders were identified. Semi-structured interviews were conducted after stakeholders completed each of the six SHUTi intervention sessions. Questions focused on improving program relatability and engagement for Black women. Key themes pertinent to peripheral, evidential, and sociocultural strategies for cultural adaptation were identified using thematic content analysis, and adaptation recommendations were developed. A total of 50 interviews, across 9 stakeholders, were conducted. Two overarching themes were identified: (i) there was limited visual African American representation, and (ii) there was a lack of diversity in the environments and lifestyles of the patient vignettes. Respondents provided peripheral, evidential, and sociocultural recommendations for program modifications, emphasizing the importance of race-concordant visual content and didactic content exploring the diverse cultural and social contexts in which insomnia occurs for Black women. As more diverse patients seek evidence-based insomnia treatment, digital health interventions must consider whether it is therapeutically important to address and tailor for cultural differences. Here, stakeholders made clear recommendations for taking cultural contexts into account to improve patient engagement with the program. Further research should work to understand the extent to which culturally tailored interventions are beneficial for health outcomes among minority populations. Lay summary Insomnia disorder is common among Black women. Cognitive-behavioral therapy for insomnia (CBT-I) is considered the gold standard treatment, but there have been few studies of this treatment in minority populations. Culturally tailoring the content of this intervention may increase a patient's willingness to seek this treatment and to respond better to the treatment. To study this, we conducted interviews with important stakeholders to determine how we should modify a proven online CBT-I intervention called Sleep Healthy Using the Internet (SHUTi). We were told that it was important to increase the amount of culturally specific visual content in the intervention materials, as well as make the stories told within the program more diverse. As we begin to see more diverse patient populations seeking evidence-based insomnia treatment, digital health interventions would be wise to consider whether developers should tailor elements of their program to recognize cultural differences.