Evaluating the Feasibility and Acceptability of Internet-Based Cognitive Behavioral Therapy for Insomnia in Rural Women

Background: Insomnia, one of the most common sleep disorders among women in midlife, is associated with multiple negative health outcomes. Rural Appalachian women are disproportionately affected by insufficient sleep, but their barriers to care (e.g., health care shortages, cultural norms) may prevent intervention. This study assessed the feasibility and acceptability of Sleep Healthy Using the Internet (SHUTi) an Internet-based version of cognitive behavioral therapy for insomnia in Appalachian women ages 45+ years. Materials and Methods: We used mixed methods to assess feasibility (through summaries of recruitment and retention data) and acceptability (quantitatively through online survey scales and qualitatively through interviews). Subject-level responses for satisfaction, adherence, and helpfulness scales were averaged over the multiple response domains and reported as percentages. Interviews were transcribed and coded using a multistage coding process. Results: Forty-six women (average age 55 years) enrolled; 38 completed the SHUTi program (retention = 82.6%). The majority of participants (61%) indicated that SHUTi made things “somewhat better” or “a lot better.” Seventy-six percent reported that they followed the SHUTi protocol “most of the time” or “consistently.” Most participants (84%) ranked SHUTi as “moderately” or “very” helpful. Participants expressed enthusiasm about SHUTi and offered minor suggestions for improvement. Conclusions: This study was the first to asses SHUTi in the health disparity population of Appalachian women. Rich insights gained through quantitative and qualitative data suggest that SHUTi was feasible and acceptable for middle-aged Appalachian women. Given rural Appalachian women\u27s documented barriers to utilizing technology, these results hold promise for SHUTi\u27s utility in other rural populations. Future research should incorporate a randomized case–control design within a larger sample and consider participants\u27 suggestions for improvement

Rural Residents\u27 Perspectives on an mHealth or Personalized Health Coaching Intervention: Qualitative Study with Focus Groups and Key Informant Interviews

BACKGROUND: Compared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities. OBJECTIVE: This study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program-Make Better Choices 2-consists of personalized health coaching, accelerometer use, and financial incentives. METHODS: We convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this novel, evidence-based diet and physical activity intervention. Participants were shown a slide presentation and asked open-ended follow-up questions. The focus group and key informant interview sessions were audiotaped, transcribed, and subjected to thematic analysis. RESULTS: We identified 3 main themes regarding Appalachian residents\u27 perspectives on this mobile health (mHealth) intervention: personal technology is feasible and desirable; challenges persist in implementing mHealth lifestyle interventions in Appalachian communities; and successful mHealth interventions should include personal connections, local coaches, and educational opportunities. Although viewed as feasible and acceptable overall, lack of healthy lifestyle awareness, habitual behavior, and financial constraints may challenge the success of mHealth lifestyle interventions in Appalachia. Finally, participants described several minor elements that require modification, including expanding the upper age inclusion, providing extra coaching on technology use, emphasizing personal and supportive connections, employing local coaches, and ensuring adequate educational content for the program. CONCLUSIONS: Blending new technologies, health coaching, and other features is not only acceptable but may be essential to reach vulnerable rural residents

Persistent Disparities in Smoking among Rural Appalachians: Evidence from the Mountain Air Project

BACKGROUND: Adult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior. METHODS: A cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015-2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed. RESULTS: MAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51-2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking. CONCLUSIONS: Despite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use

The relationship between psychosocial factors, self-care, and blood sugar in an Appalachian population

Introduction: Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality. Methods: This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community–based sample of 356 adults with diagnosed diabetes or HbA1c \u3e 6.5 was conducted in six counties in Appalachian Kentucky. Results: Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial factors and dependent variables (problem areas in diabetes, T2DM self-care or HbA1c). Results also suggest that distress is a predictor of problem areas in diabetes, and both distress and empowerment are predictors of T2DM self-care. Implications: This study addresses the gap in the literature concerning the influence of psychosocial factors on problem areas in diabetes, T2DM self-care and HbA1c among vulnerable rural residents, as well as the potential mediating/modifying effects of religiosity and social function/support. Future research is needed to inform strategies for identifying and addressing distress among vulnerable populations burdened by T2DM, including Appalachian adults

EVALUATING TRENDS IN K-12 TEACHERS’ WELL-BEING AND CAREER PLANS THROUHGOUT THE COVID-19 PANDEMIC

The COVID-19 pandemic has had far reaching effects on school communities, which will continue to affect the teaching profession for years to come. As K-12 teachers worked to meet the educational, social, emotional and health needs of students and families, their personal well-being was taxed. It is critical to understand the experiences of K-12 teachers during the COVID-19 pandemic and to leverage this understanding to develop effective strategies for supporting K-12 teachers in the future. This research leveraged data from the School Staff Health and Wellness Study to examine teachers’ well-being and career outlook during the COVID-19 pandemic. The central hypothesis was ‘adverse work environment factors during the COVID-19 pandemic would have significant effects on teachers’ well-being and future career plans.’ In the first study, the association between K-12 teachers’ satisfaction with their technological training and their well-being during Fall 2020 was evaluated. Following a mixed methods design, ANCOVA tests were used to compare means of scores on validated measures of stress, anxiety, depression, well-being and sleep among teachers who were satisfied with their technology training, unsatisfied with their training and who did not receive technology training. To complement quantitative analyses, content analysis was conducted to understand the breadth of responsibilities teachers assumed in Fall 2020. Participants’ responses to the following open-ended question were analyzed: “When preparing to teach in Fall 2020, what else did you have to do?” The majority (88%) of participants reported having to learn new technology yet approximately half (54%) felt unsatisfied with the training they received. When compared with teachers who were unsatisfied with their technology training, those who were satisfied with their training were less anxious, depressed, stressed, had lower sleep disturbance, and scored higher on measures of well-being. The second study focused on evaluating the association between teachers’ work environment and plans to continue teaching. A multivariable logistic regression model was fit to data describing teachers’ working conditions and future career plans. Results suggest that 27% of teachers were considering leaving the profession in Fall 2020. The following five factors were associated with teachers considering leaving their profession: low satisfaction with COVID-19 related decision making (aOR=2.50), poor mental health (aOR=2.31), lower levels of supervisor support (aOR=1.88), significant job duty changes (aOR= 1.51), and greater fear that a household member would contract COVID-19 (aOR=1.37). In the third study, trends in teachers’ well-being throughout the COVID-19 era were evaluated. Longitudinal analysis of teachers’ scores on validated measures of stress, anxiety, depression, well-being, and sleep disturbance was undertaken. Findings indicate that from Fall 2020 to Spring 2022, average anxiety, depression, stress and sleep disturbance decreased among teachers as overall well-being scores improved. Access to supervisor support and normalization of working hours to pre-pandemic levels were associated with improved well-being. Concurrently, the percentage of teachers who were teaching remotely dropped from 30% to 1% respectively. Concurrently, approximately 20% of teachers reported “poor” mental health. From Fall 2020 to Spring 2022, the percentage of teachers who endorsed plans to continue teaching fell from 73% to 67%. In conclusion, this dissertation aimed to enhance understanding of the impacts of the COVID-19 pandemic on K-12 teachers’ well-being and career plans. Ultimately the goal of this work is to guide policies and interventions to foster resilient and supportive school communities. Understanding the experiences of K-12 teachers during the COVID-19 pandemic is critical to effectively supporting members of school communities amid future challenging circumstances