SECTION 7 EDUCATION AND TRAINING

Public and Patient Education

Background

Support and promotion of health education is a necessary step to establish links between basic science and clinical outcomes, and to facilitate the translation of research findings to address public health concerns such as those outlined in the Department of Health and Human Services 'Healthy People 2010' initiative. Health education initiatives support primary prevention and increase recognition of sleep disorders in the general community, as well as broaden the scope of secondary and tertiary prevention efforts in patients with diagnosed sleep disorders. Public education campaigns provide information to increase knowledge, to enable modification of health risks, and also to help foster a supportive social environment for facilitating positive behavioral change. In order to accomplish these goals, effective teaching tools and strategies need to be developed, and mechanisms need to be implemented for evaluation of sleep educational materials for the general public.

It is important to delineate the educational needs of the target audience, define and prioritize the educational messages, and identify potential opportunities and barriers related to behavioral health-related change. Specific topics that have been identified as key components in public and patient sleep education programs include those related to basic regulation of sleep and circadian rhythms, sleep deprivation (extent, signs, causes, and consequences) and sleep hygiene. Sleep disorders that are prevalent, serious, and/or frequently under recognized are another key component, including SDB, insomnia, narcolepsy, and Restless Legs Syndrome/Periodic Limb Movement Disorder (RLS/PLMD). Target audiences may be defined by high risk for sleep disorders and/or sleep deprivation by virtue of age (elderly, adolescents), demographics (minority, medically underserved), gender (pregnant and menopausal women, young adult males), other health risks (obesity), and work schedules (shift workers, commercial drivers).

Educational campaigns directed towards high risk populations (e.g., adolescents) and toward receptive audiences (e.g., elementary school children) may be efficient and cost-effective ways to enhance prevention and early detection of sleep problems. These campaigns also need to include groups that can facilitate behavioral change but may hard to reach, including teachers, coaches, school nurses/health educators, parents, and pediatricians). Specific educational strategies should include culturally sensitive materials appropriate for a range of literacy levels and novel methods of translation and dissemination of information, (e.g., web-based products). Finally, outcome measures to assess the effectiveness of educational interventions include changes in knowledge, attitudes, health-related behaviors, and ultimately in the health of the target audience. Process measures describing the extent to which information is disseminated, programs are utilized, and target audiences are reached, may be surrogate measures for evaluating impact.

Progress In The Last 5 Years

The National Center on Sleep Disorders Research (NCSDR), part of the National Heart, Lung and Blood Institute (NHLBI), coordinates public and patient sleep disorders education in collaboration with the Office of Prevention, Education, and Control (OPEC) to facilitate the translation and dissemination of research and scientific consensus to the general public, patients, and health professionals. Recent sleep education programs include:

- Initiation of a 5 year media-based public awareness campaign on Sleep-Disordered Breathing (SDB).

- Development of fact sheets for the public and patients on sleep disorders including SDB, Insomnia, Narcolepsy, Restless Legs Syndrome, and problem sleepiness. Companion booklets for primary care physicians have been developed, and published in the American Family Physician journal. Partnerships with professional organizations such as the American Academy of Family Practice, the American Academy of Pediatrics, the American Sleep Apnea Association, the American Academy of Sleep Medicine, and other national sleep disorder organizations, have enabled wider dissemination of these materials than would otherwise have been possible.

- Development of the NCSDR web site, www.nhlbi.nih.gov/sleep, where educational materials are available and can be viewed and downloaded.

- Development of a 'Sleep IQ' quiz to raise public awareness of the signs of sleep deprivation and the symptoms of sleep disorders.

- Development of drowsy driving educational campaign targeted at high school students in partnership with the National Highway Traffic and Safety Administration.

- Initiation of Latino sleep education efforts, including translation of selected materials into Spanish and development of lay health educator programs. Implementation of school-based interventions to encourage awareness of sleep as a health issue and to foster healthy sleep habits in children and adolescents. These include the "Sleep well. Do well. Star Sleeper" campaign for 7 to 11 year old children, and a high school supplemental curriculum on the biology of sleep, "Sleep, Sleep Disorders, and Biological Rhythms." The school-aged intervention highlights Garfield as the "spokescat" for healthy sleep and includes classroom activities, national and local media components, and a website with separate content for children, teachers, and pediatricians

Research Recommendations

- Develop effective and innovative educational approaches based on needs assessments of high risk and target groups that include both quantitative and qualitative research methodologies. These approaches should identify specific educational opportunities and barriers, target sleep health educational interventions, and improve strategies for dissemination of educational materials to patients and the general public.

- Evaluate the effectiveness of:

> public sleep education initiatives on public health outcomes in high risk, minority, and medically underserved populations.

> school-based sleep education programs on knowledge, attitudes, and sleep practices of children and adolescents, parents, and teachers.

> educational efforts directed to relevant state regulatory agencies (e.g., departments of motor vehicles) and related to adverse consequences of sleep deprivation and sleep disorders on safety including drowsy driving, and to identifying education efforts that have positive impact on public education and safety.