Feasibility of Sleep Self-Management Intervention in Pregnancy Using a Personalized Health Monitoring Device: Protocol for a Pilot Randomized Controlled Trial

Background: Sleep disruptions are common during pregnancy and associated with increased risk of adverse maternal outcomes such as preeclampsia, gestational diabetes, prolonged labor, and cesarean birth. Given the morbidity associated with poor sleep, cost-effective approaches to improving sleep that can be disseminated in community or clinical settings are needed. Personal health monitor (PHM) devices offer an opportunity to promote behavior change, but their acceptability and efficacy at improving sleep in pregnant women are unknown. Objective: The goal of the paper is to describe the protocol for an ongoing pilot randomized controlled trial that aims to establish the feasibility, acceptability, and preliminary efficacy of using a PHM device (Shine 2, Misfit) to promote sleep during pregnancy. Methods: The proposed pilot study is a 12-week, parallel arm, randomized controlled trial. Pregnant women, at 24 weeks gestation, will be randomized at a 1:1 ratio to a 12-week sleep education plus PHM device group or a sleep education alone comparison group. The primary outcomes will be measures of feasibility (ie, recruitment, enrollment, adherence) and acceptability (ie, participant satisfaction). The secondary outcomes will be self-reported sleep quality and duration, excessive daytime sleepiness, fatigue, and depressive symptoms. Results: Recruitment for this study began in September 2017 and ended in March 2018. Data collection for the primary and secondary aims was completed in August 2018. We anticipate that the data analysis for primary and secondary aims will be completed by December 2019. The results from this trial will inform the development of a larger National Institutes of Health grant application to test the efficacy of an enhanced version of the sleep intervention that we plan to submit in the year 2020. Conclusions: This study will be the first to apply a PHM device as a tool for promoting self-management of sleep among pregnant women. PHM devices have the potential to facilitate behavioral interventions because they include theory-driven, self-regulatory techniques such as behavioral self-monitoring. The results of the study will inform the development of a sleep health intervention for pregnant women. Trial Registration: ClinicalTrials.gov NCT03783663; https://clinicaltrials.gov/ct2/show/NCT03783663 (Archived by WebCite at http://www.webcitation.org/779Ou8hon) International Registered Report Identifier (IRRID): DERR1-10.2196/1245

Knowledge, attitudes and application of evidence-based practice by third and fourth year undergraduate nursing students at the University of Rwanda (UR)

Evidence-based practice (EBP) is an important component in improving the health care outcomes of a country's population. Despite the importance and relevance of EBP to nursing, nurses do not routinely understand and use evidence-based principles in their everyday practice. This may influence the attitudes and knowledge of students who do not become exposed to the practice of EBP during their training. Nurses, who are considered to be the backbone of the health care profession, especially in Sub-Saharan Africa, should be introduced to the basic principles of EBP during their pre-registration programmes. Moreover, EBP teaching input should be both theoretical and practical with continuity throughout the whole nursing programme. The aim of this study was to determine the knowledge of, attitudes towards and application of EBP by nursing students from the College of Medicine and Health Sciences at the University of Rwanda. The study design was quantitative, descriptive and non-experimental. A total of 82 students participated in the study. An anonymous, self-reported questionnaire was used to collect data from third- and fourth-year nursing students from the College of Medicine and Health Sciences. Ethical approval was obtained from the Human Research Ethics Committee at the University of Cape Town's Health Sciences Faculty, and from the Directorate of Science, Technology and Research at the Rwandan Ministry of Education

Dietary Transition, Food Choice Process, and Food Practices in Sub-Saharan African Pregnant Women Living in Massachusetts

The purpose of this study was to explore dietary transition, food choice process, and food practices among Sub-Saharan African (SSA), immigrant, pregnant women in Massachusetts. A narrative design with a photovoice approach was used to examine how pregnant SSA immigrants navigated dietary transition and food choice in their host country versus home countries. Data were collected through semi-structured interviews, digital food diaries, and photovoice interviews. Participants were recruited through community gatekeepers at African churches and an African community center. Data were analyzed using a constructivist grounded theory approach with constant comparative methods. Validating research trustworthiness included ensuring methodology and sample appropriateness for the research question, triangulating data sources, and member checks, memos, and journaling to clarify researcher bias. This study’s findings indicate a strong preference by participants to maintain an “African diet” as much as possible. Specifically, the findings reveal that (1) participants traversed a multi-staged food transition process that was impacted by their self-perceptions, the accessibility and availability of food, and the need to adapt; (2) participants’ choice to maintain an “African diet” in their new context involved five domains: conception, intuition, reality, practicability, adjustment; (3) in the adjustment phase, participants worked with what was available to them to maintain a diet close to what they were accustomed; (4) participants’ perceptions of what made a healthy diet was an important factor in food choice, particularly due to being pregnant; and (5) participants recommended new tools to navigate nutritional information that could inform their dietary decisions. Findings from this study highlight critical times during the dietary transition and food choice process that could be useful in preventing dietary acculturation and unhealthy eating habits. The SSA immigrant dietary practices and processes illustrated in this study provide a foundation for designing – in collaboration with the community – informed, focused, and culturally tailored nutrition programs

Feasibility of a pilot, randomized controlled trial using a personalized health monitoring device with pregnant women for behavioral sleep research

Sleep disruptions are common in pregnancy and can have significant maternal and infant health consequences. Management of sleep using a personal health monitoring (PHM) device may be effective in promoting behavior change and contribute to improved pregnancy-related sleep. The purpose of this pilot, randomized controlled trial was to determine the feasibility of recruitment (i.e., recruiting a 20% minority sample, most successful recruitment methods), retention, adherence, and data collection methods with a sample of pregnant women (n = 24) at 24 weeks gestation for a 12-week intervention using a PHM device. Of 24 enrolled participants, 20 (83%) were retained through the 12-week intervention and the follow-up at 2-4 weeks postpartum. The majority of participants had a four-year education and identified as White. Ninety-one percent (n = 11) wore the device for at least ten weeks. Pregnant women may be willing engage in sleep intervention research and wear a PHM to self-monitor sleep during pregnancy. Future research should consider recruitment methods tailored to recruit diverse populations of pregnant women

The Preliminary Efficacy of a Sleep Self-management Intervention Using a Personalized Health Monitoring Device during Pregnancy

Background: Sleep disturbances are common during pregnancy and are associated with the development of adverse pregnancy outcomes. Personal health monitors (PHM) can facilitate change in health behaviors, though few studies have examined their use in improving sleep during pregnancy. This pilot study aimed to characterize sleep changes during pregnancy in women participating in a self-management intervention using a PHM. Participants/Methods: Participants with low risk, singleton pregnancies from Western Massachusetts were randomized at 24 weeks gestation to receive sleep education only (n = 12) or sleep education, and PHM intervention (n = 12). The single-session sleep education was given at baseline by a registered nurse. Sleep quality, duration, efficiency, disturbances, daytime sleepiness, and fatigue were assessed at baseline and 12 weeks follow-up using questionnaires. We described mean +/- standard deviation within and between-group changes in each sleep outcome from baseline to 12 weeks follow-up. Results: The PHM arm experienced larger sleep quality improvements and daytime sleepiness than the sleep-education only arm, but the differences were not statistically significant. In the PHM arm, the Pittsburgh Sleep Quality Index (PSQI) score decreased (i.e., sleep quality increased) 1.22 +/- 2.39 (p = .16), and the Epworth Sleepiness Scale (ESS) score decreased (i.e., daytime sleepiness decreased) 1.11 +/- 2.08 (p = .15). In the sleep-education arm PSQI decreased 0.57 +/- 2.37 (p = .55) and ESS decreased 1.29 +/- 2.93 (p = .29). Neither group experienced statistically significant changes in sleep duration, efficiency, disturbances, or fatigue. Conclusion: Sleep education with PHM may improve or prevent decreases in sleep outcomes during pregnancy. Further investigation in larger trials is warranted