# A Qualitative Exploration of Multilevel Factors Affecting Sleep Quality Among Minoritized Older Adults

## TL;DR

This study explores factors affecting sleep quality in older African American and economically marginalized adults and suggests ways to design effective sleep interventions.

## Contribution

The study identifies multilevel sleep barriers and intervention preferences in a marginalized older adult population.

## Key findings

- Sleep issues were influenced by individual worries, pain, and household/neighborhood factors like noise and security concerns.
- Participants preferred non-medical interventions, regular community health worker contact, and sleep-tracking devices.
- An intervention tailored to these community-specific needs could be both acceptable and effective.

## Abstract

Poor sleep is a risk factor for dementia and other chronic conditions, and disproportionately affects African American and economically marginalized older adults. Drivers of sleep inequities exist at the individual, household/neighborhood, and structural levels. We conducted 21 semi-structured interviews with adults aged 50 to 74, 77% African American, who reported persistent “poor” or “very poor” sleep quality over 2+ months. We sought to identify the multilevel factors that impact sleep and elicit feedback on potential components of a behavioral sleep intervention tailored for this community. Using a rapid qualitative analysis approach, we first developed a template reflecting domains of interest (e.g., factors hindering sleep), and then extracted data from transcripts for each domain. We aggregated and reviewed data for main findings. Results revealed that sleep impediments were multilevel. Individual level factors included feeling worried/anxious and being disturbed by pain. Household/neighborhood factors were needing to be “on alert” at night due to security concerns or to care for elderly parents, noise from adult children or pets, and sleeping in a too-warm room. Most participants did not have difficulty falling asleep but woke up repeatedly and had trouble going back to sleep. Appealing features of an intervention included improving sleep without medications; having regular contact with a community health worker; wearing a watch to track sleep; and resources such as videos and podcasts. Findings suggest that a behavioral sleep intervention tailored to the specific needs of older adults in a marginalized community has the potential to be both acceptable and efficacious.