# Exploring climate and context to inform implementation of a brief sleep health program for older primary care patients

> **NIH NIH R21** · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 2022 · $193,750

## Abstract

ABSTRACT. Healthy-sleep wake patterns are critical to older adults’ cognitive health, functional capacity,
mood, and overall quality-of-life. Up to two-thirds of older adults complain of insomnia symptoms, including
difficulty falling or staying asleep, or poor nighttime sleep that results in daytime dysfunction. Despite the high
prevalence of insomnia symptoms, as few as 25% of older adults have discussed sleep with a doctor.
Insomnia can be safely and effectively treated with evidence-based behavioral treatments, including Cognitive
Behavioral Therapy for Insomnia (CBTI). However, access to CBTI remains limited and few programs have
been designed to meet the needs of older adults. Identifying existing care pathways, including primary care
services, may help improve access to CBTI. Our team has previously developed and tested an effective
behavioral sleep intervention designed to accommodate older adults’ cognitive and functional needs. Rooted in
principles of CBTI, our four-session intervention was associated with objective improvements in nighttime sleep
and subjective decreases in daytime dysfunction. The proposed research extends our team’s prior work and is
the first step towards scale out of this effective geriatric insomnia intervention from VA to non-VA medical
settings. This proposal is guided by the Exploration, Preparation, Implementation, and Sustainability (EPIS)
Framework to explore the implementation climate and culture of local primary care clinics in regards to
implementation of a brief insomnia intervention. This two-phased study includes an explanatory sequential
mixed methods study followed by a series of co-design sessions to understand the implementation climate and
context of local primary care settings, and to refine intervention procedures and implementation strategies. The
study aims are as follows: Aim 1. Examine implementation climate and context related to integration of an
evidence-based insomnia intervention for older adults seeking care in primary care clinics. Aim 1a. Identify
current clinical practices related to insomnia in older adults, including estimated frequency of insomnia
complaints, current assessment procedures, and available treatments. Aim 1b. In collaboration with patient and
provider stakeholders, explore implementation barriers and facilitators. Aim 2. Engage key stakeholders
(patients and providers) in a collaborative, co-design process to refine intervention procedures and
implementation strategies. Quantitative surveys collected from patients and providers in Aim 1a will identify
insomnia knowledge, beliefs, and attitudes as well past experiences with primary care-based insomnia
screening and treatment. Survey findings will inform semi-structured interviews in Aim 1b. Co-design sessions
with each patients and providers will determine how to integrate the intervention into local practices (e.g.,
training providers, screening procedures, and mode of intervention delivery). Findings generated by t...

## Key facts

- **NIH application ID:** 10448552
- **Project number:** 1R21AG073899-01A1
- **Recipient organization:** WAKE FOREST UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Jane M Hughes
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $193,750
- **Award type:** 1
- **Project period:** 2022-09-15 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10448552

## Citation

> US National Institutes of Health, RePORTER application 10448552, Exploring climate and context to inform implementation of a brief sleep health program for older primary care patients (1R21AG073899-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10448552. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*