Effects of a Sleep Health Education Program for Children and Parents on Child Sleep Duration and Difficulties

Abstract

IMPORTANCE Preschool-aged children often lack sufficient sleep and experience sleep difficulties. A consistent bedtime routine, falling asleep alone, and other sleep practices reduce difficulties and increase sleep duration. OBJECTIVE To evaluate the effects of a preschool-based sleep health literacy program on children's sleep duration and difficulties and on parent sleep knowledge, attitudes, self-efficacy, and beliefs 9 and 12 months after the program. DESIGN, SETTING, AND PARTICIPANTS This stepped-wedge cluster randomized clinical trial was implemented across the 2018-2019 school year. Head Start preschool personnel delivered interventions and collected outcomes data at baseline and 4 follow-ups. Seven Head Start agencies across New York State were randomized to implement interventions in either fall 2018 or winter and spring 2019. Outcomes were ascertained at 9-and 12-month follow-up. From March 19 through September 28, 2018, Head Start staff recruited (a) English-or Spanish-speaking parents (b) of children 3 years of age on or about September 2018 (c) who planned to remain at the site through the school year. Altogether, 519 parent-child (aged 3 years) dyads completed baseline and (any) followup data. INTERVENTIONS A 2-week classroom curriculum for children, a 1-hour parent workshop, and 1-on-1 parent discussions at home or school. MAIN OUTCOMES AND MEASURESOutcomes were the pre-vs postintervention differences measured at baseline and 9-month follow-up for parent-reported child school-night sleep duration per sleep logs, mild or moderate sleep difficulties per a validated questionnaire, and the total and domain scores for parent sleep knowledge, attitudes, self-efficacy, and beliefs. A modified intentionto-treat analysis excluding participants with only baseline data was used. RESULTSThe mean (SD) age at enrollment of 519 children was 2.7 (0.1) years, 264 (50.9%) were girls, 196 (37.8%) lived in Spanish-speaking households, and 5 (0.9%) identified as Alaskan Native or American Indian, 17 (3.2%) as Asian American or Pacific Islander, 57 (10.8%) as Black, 199 (37.8%) as White, and 63 (12.0%) as other. Mean sleep durations increased nonsignificantly from baseline by 5.6 minutes (95% CI, −2.3 to 13.6 minutes; P = .17) at 9-month follow-up and by 6.8 minutes (95% CI, 0.2-13.7 minutes; P = .06) at 12-month follow-up. There was a slight improvement in parental knowledge (1.13 unit increase from baseline; 95% CI, 0.13-2.12 units), but no significant outcomes for parent sleep attitudes (0.16 unit increase from baseline; 95% CI, −0.46 to 0.77 units), self-efficacy (−0.13 unit decrease from baseline; 95% CI, −1.02 to 0.76 units) and beliefs (−0.20 unit decrease from baseline; 95% CI, −0.56 to 0.16 units). Intervention effects for child sleep difficulties were not (continued) Key Points Question Does a sleep health education program for children and parents in Head Start improve childhood sleep and related outcomes? Findings This stepped-wedge cluster randomized clinical trial of 519 parentchild (aged 3 years at enroll...

School-Based Sleep Education Program for Children: A Cluster Randomized Controlled Trial

“…The increase in parental sleep knowledge after sleep education was found to be consistent with previous studies targeting preschool and school-aged children [ 26 , 36 , 37 ]. Notably, a recent pragmatic and prospective stepped-wedge cluster trial on the sleep health education program also resulted in improvements in parental knowledge but found clinically insignificant improvements in the sleep outcomes [ 37 ]. It seems that the increase in parental knowledge alone is not sufficient to result in improved children’s practice [ 38 ].…”

“…It seems that the increase in parental knowledge alone is not sufficient to result in improved children’s practice [ 38 ]. This discrepancy may be partly due to the gap between parental perceptions and actual sleep requirements in children [ 37 , 39 , 40 ], as parents tend to underestimate the sleep needs and the presence of sleep difficulties in their children [ 38 , 39 ]. In addition, even though parents and teachers were provided with sleep health workshops in the current study design, parental involvement was not compulsory, and less than one-third of the parents in the intervention group (mother: 30.2%; father: 19.1%) reported their engagement in the program, whereas the degree of their engagement was not documented.…”

“…The insignificant intervention effects observed in the children’s sleep-wake patterns and sleep difficulties in the current study were somehow inconsistent with previous children sleep interventions which demonstrated a significant improvement in both subjective and objective sleep measures after the intervention [ 24 , 25 , 26 , 27 ]. This inconsistency might be due to the differences in methodologies, as previous studies were of a relatively small sample size [ 24 , 26 , 27 , 28 ], narrower age group [ 24 , 25 , 26 , 28 ], non-randomized controlled study design [ 24 , 26 , 28 ] and targeting at-risk children (e.g., children with sleep disturbance) or clinical samples [ 25 , 27 ], which may all increase the intervention effects [ 37 , 44 ]. A recent review has overall concluded that sleep intervention in healthy children, albeit with an average of a 10.5 min longer sleep duration, has very small effects and a limited clinical implication [ 45 ].…”

“…The findings of the current study add to the existing literature that school-based sleep education is insufficient in changing children’s actual sleep practice, at least from a parental perspective. Even if parents had increased sleep knowledge, their understanding of children’s sleep requirements and their practices may still be inadequate [ 37 , 39 , 40 ]. Thus, future studies should consider including a more active parental involvement [ 41 , 42 , 43 ], and further developing sleep education with a specific focus on advancing bedtime.…”

Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial—a stepped wedge cluster randomized trial protocol

“…Secondly, the stepped wedge design is advantageous as it permits researchers to progressively introduce and assess the various components of an intervention, while continuously optimizing the intervention [ 36 ]. Examples of stepped wedge investigations include the efficacy of 3 cancer pain guideline implementation strategies [ 37 ] and effects of a preschool-based sleep health literacy program [ 38 ]. The POFHM intervention is brief, and patients are unlikely to have repeat medical visit in the short term.…”