A qualitative study of multilevel barriers and facilitators influencing sleep of black women in Connecticut, United States.

backgroundBlack women are more likely to experience sleep difficulties compared to their White counterparts. This disparity may be fueled by differences in economic opportunities, race - and gender-based discrimination, and other societal factors. Guided by the socio-ecological model, the purpose of this study was to examine the multi-level barriers and facilitators of sleep among Black women in the United States.

methodsA qualitative description study design was used. Semi-structured interviews were conducted in English among 28 Black women with sleep difficulties. Interviews were audio-recorded and transcribed. Thematic analysis was used to analyze data.

resultsParticipants (mean age = 47.3 years) were primarily single (52%) and employed (84%). Through qualitative interviews, four key themes emerged: (a) Individual-level barriers and facilitators, such as chronic health issues, poor sleep hygiene, stress, trauma, financial strain, and coping strategies like prayer and relaxation routines; (b) Interpersonal influences, including caregiving demands, emotional burdens from family dynamics, and social support; (c) Community-level factors, such as neighborhood noise, violence, and safety concerns contributing to hypervigilance; and (d) Societal-level influences, notably the "strong Black woman" schema and experiences of racism and gendered discrimination, which shaped sleep experiences. DISCUSSION AND

conclusionBlack women's sleep is impacted by intersecting factors across individual, interpersonal, community, and societal levels. Culturally grounded, trauma-informed, and equity-focused interventions, targeting all socioecological levels, are essential to improve sleep health of Black women.