The three aims of this study are: l) to describe significant environmental and physiological correlates of disturbed sleep for 105 ethnically diverse women who are HIV seropositive; 2) to describe and contrast strategies these women use to manage their daily activities within the context of their complex environment; and 3) to develop and pilot test an educational intervention to enhance sleep efficiency and daily activities. In this study, a woman's complex environment includes components in her socio- cultural, home, and physiological life. Symptom experience includes her distress related to a variety of somatic symptoms, her level of depression, and her level of fatigue. Symptom response includes amount of consolidated sleep, level of daytime activity, and strategies used by these women to manage their daily lives within the context of their environment and symptom experience. Data will include demographics to obtain environment variables, the Brief Symptom Checklist to assess distress, the Center for Epidemiologic Studies Depression Scale, an Inventory of Functional Status to estimate daytime activities, and the Visual Analog Scale for Fatigue to assess morning and evening fatigue. A motion sensor (wrist actigraph) will be worn to monitor sleep efficiency and level of activity continuously for 48 hours and a 2-day diary will be used to obtain subjective indicators of sleep and wake times, meal and exercise times, and distressful symptom experiences. Environmental factors and symptom experiences that significantly predict sleep efficiency will be determined from a multiple regression analysis. An intervention will be developed from the management strategies described by the women, in conjunction with principles of sleep hygiene. The intervention will be pilot tested with the final 25 women in the sample using a paired t-test to compare pre- and post-intervention sleep efficiency scores, and the efficacy of the intervention will be assessed. The findings from this study will provide data on the multi-faceted environmental context and symptom experiences for women with HIV. Data from this study will also provide a gender specific and culturally relevant nursing intervention based on empirical data that can be further tested in other samples of women with chronic illness.
