Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions

Abstract

Study objectives: This review synthesizes the pediatric behavioral sleep intervention (BSI) evidence base, summarizes challenges in translating BSIs from research to practice, and provides recommendations for integrating implementation science methods to advance pediatric BSI research.

Methods: We briefly review the common behavioral sleep disturbances among youth, discuss the pediatric BSIs with well-established evidence, and identify gaps in pediatric BSI research. We then identify contributors to the dearth of research evaluating pediatric BSIs in accessible settings and present a model for applying implementation science strategies to address identified gaps across the continuum of translational research.

Results: Relatively few BSI trials include older children and adolescents. Similarly, there is limited research evaluating BSIs among racially and ethnically minoritized children and families and/or those of lower socioeconomic status backgrounds. Access to scalable and easily disseminable tools to treat pediatric sleep disturbances early in their development is crucial for promoting positive child outcomes. To address these gaps, researchers should apply implementation science theories, models, and frameworks to design new interventions for implementation, adapt existing interventions with end users and settings in mind, conduct hybrid effectiveness-implementation trials, and test implementation strategies.

Conclusions: Given the prevalence and consequences of poor sleep across developmental periods, pediatric BSIs must be effective as well as adaptable, scalable, and easily disseminable. Implementation science theories, models, and frameworks can enhance access to, engagement in, and the implementation and dissemination of scalable BSIs across diverse pediatric care settings and heterogeneous populations.

Citation: Levenson JC, Williamson AA. Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions. J Clin Sleep Med. 2023;19(7):1321-1336.

Keywords: adolescence; behavioral; childhood; dissemination; effectiveness; implementation; intervention; minoritized; pediatrics.

Figure 1. Implementation science subway line.

Graphic has been tested with colorblindness filters to ensure readability. *In some cases it may be appropriate to move forward with a hybrid type I trial in the absence of effectiveness evidence (eg, very strong efficacy, indirect evidence supportive of potential effectiveness in context of interest, and/or strong momentum supporting implementation in a health care context). Reprinted with permission from Lane-Fall et al.