0467 A Health Literacy Adaptation of Brief Behavioral Therapy for Insomnia for English and Spanish -Speaking Economically Marginalized Adults

Abstract Introduction Economically marginalized adults experience disproportionate insomnia burden and face barriers to accessing behavioral insomnia treatments. Health literacy–adapted interventions can reduce participant burden, improve understanding, and enhance behavioral enactment. We iteratively adapted an evidence-based Brief Behavioral Treatment for Insomnia (BBTI) for English- and Spanish-speaking economically marginalized adults for use in an effectiveness trial. Methods Participants (Mage = 42.1 ± 15.4; 60% non-Hispanic/Latino; 14 female) rated the adapted manual as clear, easy to follow, and respectful in tone, confirming it as a “good program”. User feedback informed several refinements: (1) enhanced visual clarity by simplifying graphics (e.g., a new homeostatic sleep drive illustration); (2) expanded insomnia education (definitions, risk factors, perpetuating mechanisms); (3) revised wording to increase clarity, actionability, and patient-friendliness (e.g., replacing “rules” with “steps”); and (4) added guidance for common barriers (e.g., shift work, caregiving). Pilot testing (Mage = 40.4 ± 4.0; 40% Hispanic/Latino; 3 female) supported high overall acceptability and usability of the adapted materials (e.g., “easy to understand”) and improved insomnia severity (ISI Mpre = 17.0 ± 4.2; Mpost = 10.0 ± 1.0). Results Participants (Mage = 42.1 ± 15.4; 60% non-Hispanic/Latino; 14 female) rated the adapted manual as clear, easy to follow, and respectful in tone, confirming it as a “good program”. User feedback informed several refinements: (1) enhanced visual clarity by simplifying graphics (e.g., a new homeostatic sleep drive illustration); (2) expanded insomnia education (definitions, risk factors, perpetuating mechanisms); (3) revised wording to increase clarity, actionability, and patient-friendliness (e.g., replacing “rules” with “steps”); and (4) added guidance for common barriers (e.g., shift work, caregiving). Pilot testing (Mage = 40.4 ± 4.0; 40% Hispanic/Latino; 3 female) supported high overall acceptability and usability of the adapted materials (e.g., “easy to understand”) and improved insomnia severity (ISI Mpre = 17.0 ± 4.2; ISI Mpost = 10.0 ± 1.0). Conclusion Health literacy–informed adaptations improved the usability and acceptability of BBTI materials for economically marginalized English- and Spanish-speaking adults. Incorporating health-literate design may reduce patient burden and enhance fidelity and effectiveness of behavioral insomnia interventions. Support (if any) This work was supported by the American Academy of Sleep Medicine.