Social-ecological considerations for the sleep health of rural mothers
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Social‑ecological considerations for the sleep health of rural mothers Alexandra R. Fischer1 · Sha‑Rhonda M. Green2 · Heather E. Gunn1
Received: 11 July 2020 / Accepted: 30 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Using a social-ecological framework, we identify social determinants that interact to influence sleep health, identify gaps in the literature, and make recommendations for targeting sleep health in rural mothers. Rural mothers experience unique challenges and protective factors in maintaining adequate sleep health during the postpartum and early maternal years. Geographic isolation, barriers to comprehensive behavioral medicine services, and intra-rural ethno-racial disparities are discussed at the societal (e.g., public policy), social (e.g., community) and individual levels (e.g., stress) of the social-ecological model. Research on sleep health would benefit from attention to methodological considerations of factors affecting rural mothers such as including parity in population-level analyses or applying community-based participatory research principles. Future sleep health programs would benefit from using existing social support networks to disseminate sleep health information, integrating behavioral health services into clinical care frameworks, and tailoring culturally-appropriate Telehealth/mHealth programs to enhance the sleep health of rural mothers. Keywords Rural · Sleep health · Women’s health · Social-ecological model · Ethno-racial disparities
* Heather E. Gunn [email protected] 1
Department of Psychology, University of Alabama, Box 87034, Tuscaloosa, AL 35487, USA
2
School of Social Work, University of Alabama, Tuscaloosa, USA
Introduction Sleep health is a critical element of women’s health across the lifespan (Jackson et al. 2020). Sleep health comprises parameters such as duration, continuity, and timing, which are strongly linked to health and well-being (Buysse 2014). Although epidemiological studies indicate little variance between women and men in obtaining sufficient sleep (Grandner 2019), women generally experience greater risk for insomnia (Petrov et al. 2014) and report greater sleep disturbances and worse sleep quality than men (Wang et al. 2018), particularly during life transitional phases with reproductive hormonal change (Meers et al. 2019). Anticipated physiological and psychosocial changes associated with the perinatal period (before and after childbirth) challenge the maintenance of sleep health across pregnancy, immediate postpartum, and the early years of motherhood (Christian et al. 2019). Moreover, poor maternal sleep health can contribute to concomitant downstream negative health consequences such as postpartum depression (PPD; Bhati and Richards 2015; Carroll et al. 2019; Okun et al. 2018), chronic pelvic pain disorders (Cheng and Li 2008; Cosar et al. 2014) and cardiovascular disease risk (Troxel et al. 2010). Thus, motherhood brings about many changes to sleep health, which in turn contributes to othe
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