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

Abstract

Insufficient sleep contributes negatively to child developmental processes and neurocognitive abilities, which argues the need for implementing interventions to promote sleep health in children. In this study, we evaluated the effectiveness of a multimodal and multilevel school-based sleep education program in primary school children using a cluster randomized controlled design. Twelve schools were randomly assigned to either the sleep education or nonactive control groups. The sleep education group included a town hall seminar, small class teaching, leaflets, brochures, and a painting competition for children. Parents and teachers were invited to participate in a one-off sleep health workshop. Parental/caregiver-reported questionnaires were collected at baseline and 1-month follow-up. A total of 3769 children were included in the final analysis. There were no significant improvements observed in the sleep-wake patterns, daytime functioning, and insomnia symptoms between the two groups at follow-up, whereas the intervention group had significantly improved parental sleep knowledge than the controls (paternal: adjusted mean difference: 0.95 [95% confidence interval (CI): 0.18 to 1.71]; maternal: adjusted mean difference: 0.87 [95% CI: 0.17 to 1.57]). In addition, children receiving the intervention had a lower persistence rate of excessive beverage intake (adjusted odds ratio: 0.49 [95% CI: 0.33 to 0.73]), and experienced greater reductions in conduct problems (adjusted mean difference: 0.12 [95% CI: 0.01 to 0.24]) compared with the controls at 1-month of follow-up. Moreover, a marginally significant reduction for emotional problems in the intervention group was also observed (adjusted mean difference: 0.16 [95% CI: −0.00 to 0.32]). These findings demonstrated that school-based sleep education was effective in enhancing parental sleep knowledge and improving behavioral outcomes in children, but not sufficient in altering the children’s sleep-wake patterns and sleep problems.

Brief School-Based Interventions Targeting Student Mental Health or Wellbeing: A Systematic Review

“…MAKINGtheLINK, an in-person intervention focused on increasing mental health literacy, did not result in statistically significant reductions in scores on a measure of depression and anxiety compared to a waitlist control, with small effect sizes ranging from d = 0.08 to d = 0.15 at six-weeks to twelve-month follow-ups (Lubman et al, 2020). One study examined Healthy Sleep, Health School Life, an in-person sleep education intervention, and found no statistically significant differences in parent-reported difficulties between participants in the intervention and no-treatment control group at a one-month follow-up, with a small effect size of d = -0.03 (Chen et al, 2023). In their study of a virtual-reality-based intervention, Shaw and Lubetzky (2021) found that scores on psychological stress decreased from baseline to post-intervention among the intervention group, but were not significantly different compared to the active control condition; the effect size was small, d = 0.05 (Shaw & Lubetzky, 2021).…”