Developing and Testing of Behavioral Intervention Programs for Hispanic Cancer Survivors With Insomnia

Insomnia will be assessed with the Insomnia Severity Index (ISI). A 5-point Likert scale of 7 questions is used to rate each item (e.g., 0 = no problem; 4 = very severe problem), yielding a total score ranging from 0 to 28 with higher scores indicating higher severity of insomnia.

We hypothesize that at least 50% of eligible individuals approached for the study will enroll.

We hypothesize that ≥80% of participants will complete the 1-week post-intervention assessment and ≥70% will complete the 3-month post-intervention assessment.

We hypothesize that ≥80% of participants will collect ≥75% of actigraphy data

we hypothesize that )≥70% of participants will complete ≥75% of activity & sleep logs.

Acceptability will be assessed using the Treatment Perceptions Questionnaire (TPS). Participants will rate the comprehensibility of components of the culturally appropriate interventions, as well as their length, intensity, and overall suitability for reducing sleep-quality impairment. The TPQ is available in Spanish and English. We hypothesize that ≥80% of participants will find the intervention was acceptable

Pittsburgh Sleep Quality Index (PSQI). The PSQI is a widely used, validated 19-item self-report measure of sleep quality over the past month. It yields a global score ranging from 0-21, with higher scores indicating poorer sleep quality and scores >5 indicating clinically significant sleep disturbance. The PSQI has demonstrated good internal consistency (Cronbach's α = 0.83), test-retest reliability, and construct validity.

Sleep self-efficacy will be measured with the sleep self-efficacy scale(SES). The SES is a 9-item self-report measure that assesses anindividual's confidence in their ability to achieve and maintain healthysleep. Items are rated on a 5-point Likert scale, with higher scoresindicating greater sleep self-efficacy.106 The SES has demonstratedexcellent internal consistency (Cronbach's α ≈ 0.90).

Mindfulness will be measured with the Mindful Attention Awareness Scale (MAAS), a 15-item self-report measure that assesses dispositional mindfulness, specifically an individual's awareness of and attention to present-moment experiences. Items are rated on a 6-point Likert scale, with higher scores indicating greater mindfulness. The MAAS has demonstrated excellent internal consistency (Cronbach's α =0.80-0.90) and strong construct validity and is available in both English and Spanish

Differences in physical activity outside theintervention will be assessed with the Godin-Shephard Leisure-TimePhysical Activity Questionnaire. This questionnaire is available andvalidated in English and Spanish.

Quality of Life (QOL) will be assessed via the Functional Outcomes for Cancer Therapy - General (FACT-G). This measure consists of 27 items designed to measure four domains of quality of life in cancer patients: physical, social, emotional, and functional well-being. Coefficients of reliability and validity are uniformly high. The scale's ability to discriminate among patients based on disease stage, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. The FACT-G is available and validated in English and Spanish.

Anxiety and depression will be measured with the Patient Health Questionnaire-4 (PHQ-4), a 4-item self-report measure that assesses symptoms of anxiety and depression over the past two weeks. It combines the 2-item Generalized Anxiety Disorder scale (GAD-2) and the 2-item Patient Health Questionnaire (PHQ-2), with higher scores indicating greater psychological distress. The PHQ-4 has demonstrated good internal consistency (Cronbach's α ≈ 0.81) and strong validity and is available in both English and Spanish.

Perceived stress will be measured with the Perceived Stress Scale (PSS-10), a 10-item self-report measure that assesses the degree to which individuals perceive their lives as stressful during the past month. Items are rated on a 5-point Likert scale, with higher scores indicating greater perceived stress. The PSS-10 has demonstrated good internal consistency (Cronbach's α ≈ 0.78-0.91), strong construct validity, and is available in both English and Spanish.

Fatigue will be assessed with the Functional Assessment of Chronic Illness - Fatigue (FACIT-F) Scale.120 This scale is frequently used with cancer survivors because it has established minimally important differences. This 13-item scale assesses the level of fatigue during usual activities over the past 7 days, with higher scores indicating less fatigue (score range=0-52; Cronbach's alpha=0.86). The FACIT-F is available in English and Spanish and validated in Spanish-speaking populations.

Comorbidities will be assessed with the Charlson Comorbidity Index. It is a weighted index that considers both the number and the seriousness of comorbid diseases. It consists of 19 items, each with an assigned weight from 1 to 6 according to the relative risk of dying within a year. In general, the absence of comorbidity is considered: 0-1 points; low comorbidity: 2 points; and high comorbidity:≥3 points.

Acculturation will be measured with the Short Acculturation Scale for Hispanics (SASH). The 12-item scale (explaining 67.6% of the variance for Hispanics) correlates highly with the following validation criteria: respondents' generation, length of residence in the U.S., age at arrival, ethnic self-identification, and an acculturation index. The SASH is available and validated in English and Spanish.

Actigraphy will measure the number of minutes of actual sleep.

Actigraphy will measure the percent of time actually slept compared to intended time sleeping.

Actigraphy will measure the minutes it takes for the participant to fall asleep.

Actigraphy will measure total minutes of wake time after sleep onset.

Perceived exertion will be measured after each BMT session, with the classic Borg Rating of Perceived Exertion (RPE) scale, which is a 15-point scale (ranging from 6 to 20). It has been extensively tested and validated against physiological markers. This will be collected to ensure that the BMT intervention is perceived as being of mild to moderate intensity.

Credibility/Expectancy Questionnaire (CEQ). The CEQ is a brief 6-item self-report measure assessing participants' perceived credibility of an intervention and expectations for improvement. It has demonstrated good internal consistency, with Cronbach's α generally ranging from 0.79-0.90 for credibility and 0.81-0.86 for expectancy, as well as good test-retest reliability.