0774 Refining a Primary Care Navigation Intervention to Address Sleep Disparities: Caregiver and Clinician Perspectives

Abstract

Introduction: There are well-known racial, ethnic, and socioeconomic disparities in the incidence and treatment of pediatric sleep-disordered breathing (SDB). Addressing these disparities through culturally-tailored interventions could increase effectiveness and acceptability. As care navigation models have been beneficial in addressing modifiable patient and system-level barriers to care, we qualitatively explored participants' perspectives of a sleep navigation (SN) program in primary care to inform future intervention refinement. Methods: Thirty-three English-speaking caregiver-child dyads (child Mage= 7.1□4.2 years; 51.6% girls; 100% Black, 3% Hispanic/Latinx; 93.5% maternal caregiver; 61.2% living ≤125% US poverty level) referred to SDB specialty care by their primary care provider were randomly assigned to clinical decision support (CDS) or to CDS with SN. SN was a 1-3 session program designed to support families in completing their SDB referral through motivational interviewing and care coordination strategies. Primary care clinicians (n=21) also participated in the study. We conducted semi-structured qualitative interviews with 10 caregivers (5 from CDS only, 5 from CDS + SN) and 9 clinicians to assess acceptability and perspectives on SN optimization. Interview data were coded and analyzed using thematic analysis. Results: Overall, clinicians and caregivers that received SN reported strong acceptability. Participants also noted the benefits of racial concordance for families and navigators in transferring health knowledge to improve health literacy. Caregivers reported positive changes in their child's sleep health and a better understanding of SDB. Themes related to SN refinement included adding tailored patient education such as audio-visual and written materials and enhancing strategic family-provider communication. Clinicians emphasized that SN could be enhanced beyond referral completion by including support for families needing additional SDB care (e.g., surgery) and through in-person, warm handoffs in clinics to build trust between families and navigators. Clinicians also recommended exploration of a broader navigation program that could integrate multiple primary care referrals and resource needs (e.g., food insecurity). Conclusion: SN was perceived as highly acceptable by primary care clinicians and families of primarily Black and/or lowerincome backgrounds. Sustainability of the resultant model requires additional refinement to determine optimal implementation strategies that integrate sleep navigation with other primary care needs.