Lights Out! Sleep hygiene early intervention for primary school-aged children

Lights Out! Sleep hygiene early intervention for primary school-aged children

To combat the impact of external factors on sleep hygiene in primary-school children, we have developed a campaign called Lights Out. Its aim is to decrease social media use before bed and the establishment of a strong night-time routine in primary school aged children from 5-12 years. This campaign aims to combat the impact of external factors on sleep hygiene, by providing education to children and their parents on the consequences of poor sleep, with tips to establish an effective and relaxing night-time routine.

This campaign will follow a two-staged implementation, initially experimenting with NSW primary schools, then later expanding nationwide and partnering with sponsors to spread the message. A recent study by Busch and colleagues found informational interventions to be particularly ineffective with school children aged 4-12 years, whilst a more experiential and behavioural learning style in combined settings had greater uptake and effectiveness (Busch et al., 2017). As such, implementing differing strategies to educate children and their parents in both the school and home environment will be paramount. For children, we propose biweekly classroom sessions, approximately 30-45 minutes in length, that teach practical strategies to improve quality of sleep or that can be implemented in ones night-time routine. This may include yoga to practice deep breathing exercises or art and craft sessions to create worry dolls or teddies that help ease anxiety. We see this forming part of the NSW curriculum, with varying activities each week to provide students with a breadth of strategies to utilise. Teachers will simultaneously liaise with parents to explain what has been covered in the classroom and encourage at-home practice each night. Additionally, eye-catching posters will be displayed and referred to in classrooms to ingrain key information pertaining to sleep hygiene.

It is known that parents are often most influential in a childs behaviour development, thus providing psychoeducation to carers via the campaign will complement their childs learning. An information session will be hosted each term for parents of every year group to provide scientific background along with informative guides and tips. It will be pertinent that parents and teachers maintain effective communication to discuss their childs progress and provide feedback.

To sustain engagement in sleep hygiene activities and education, teachers can implement a rewards system, such as a star chart, to encourage ongoing commitment and practice of these strategies in the home. This may involve various prizes, such as a fidget toy, weighted blanket or journal, that can also aid in emotion regulation and sleep anxiety. Ideally, conscientious students will act as role models in the classroom, subtly encouraging others to follow suit.

In the long term, after successful deployment and uptake of our campaign in NSW schools, we will expand nationwide, via catchy advertisements and signage. We envision partnering with a beloved childrens television show, such as Bluey or Paw Patrol, to both spread awareness and improve subjective norms as per the theory of planned behaviour. This will also be achieved via sponsorship from an electronics company, such as Apple, who will promote the Lights Out campaign and advocate for the importance of reducing screen time in the evening.

Rationale

Sleep plays a crucial role in the growth, learning and development of children. Poor sleep has been associated with cognitive, emotional and behavioural impairments, such as inattention, problems with concentration, memory, stress, anxiety, depression, aggression and hyperactivity. Recent research has documented an increased risk of metabolic changes such as insulin resistance, a precursor of Type 2 diabetes, and a greater likelihood of obesity.

The most common issues for children not getting sufficient sleep are not getting into bed; not settling into sleep; not staying in their own bed; waking up at night; and getting up too early in the morning. Further risk factors include living below the poverty line, lack of caregiver education on the importance of adequate sleep, adverse home-life situations, and parental mental health issues.

Over the past decade, screen-based media use has begun to play an increasing role in children's lives. Robust research has shown the use of screen devices at bedtime is associated with an increase in poor sleep quality, sleep anxiety and sleep disturbances. A recent poll found 67% of Australian primary school-aged children have their own mobile device and 43% use one at bedtime. One in six also have their own social media account. For those children who communicate with their friends via social media, the greatest concern is that they are unable to withdraw from the mental arousal state, especially if they are texting past midnight, or into the early hours of the morning.

We would now like to consider the ways parents contribute to their childs sleep problems. Low parental pre-sleep emotional support and lower parental education level are associated with irregular bedtime and inadequate sleep. Parents who actively engage with their children, by reading a book or talking with their child about their day, may reduce their childs need to partake in the use of screen devices such as gaming and social media. A strong relationship exists between parents screen use and that of their children, with parents who have high levels of screen use, reporting children who use screen devices for many hours in the day.

Current recommendations for sleep interventions include providing basic education about sleep, for example what is sleep and its health benefits, combined with sleep hygiene tips such as setting a regular sleep and wake time schedule, having a consistent bedtime routine, providing a soothing, quiet and dark bedroom, turning off computers, tablets and TV an hour before bedtime, and limiting technology use in the bedroom. Another common intervention is relaxation techniques. For children who have a hard time switching off in the evening, teaching simple deep breathing exercises, mindfulness, and muscle relaxation, that distracts the mind and slows it down, can help sleep onset and duration.

However, contention exists about whether simply educating children and parents about the importance of sleep and the risks of insufficient sleep will result in improved sleep behaviors. Findings from a RCT school-based sleep intervention saw an extra 10 mins of sleep immediately post intervention, but this disappeared 18 weeks later. Busch et al. (2017) have suggested it is more beneficial to combine a sleep intervention with other practical lifestyle changes at school and in the home, that focus on healthy eating, adequate physical activity during the day, and limiting screen use. Such a multi-factored approach has been shown to be the most effective driver of sustained behavioural change.

I will now pass over to Andreas who will talk you through how we have applied The Theory of Planned Behaviour to understand this health initiative.

Theory of Planned Behaviour

According to the theory of planned behaviour, a persons behaviour is influenced by intentions, which are determined by three factors: attitudes, subjective norms, and perceived behavioral control. In this scenario, the actual behaviour is good quality sleep. The intention is to improve the quality and duration of sleep.

For children aged 5-12 years of age, it is important to look at what their attitude towards sleep is. Children will not make healthy choices around sleep if they do not value sleep as an important resource. Some children will have experienced the detrimental effects of insufficient sleep and feel happy about going to bed, while others may feel resistant at bedtime because they prefer staying up late with their parents or playing on screen devices.

Changing attitudes through education for children, while implementing a sleep chart and reward system in the classroom, would be a tremendous motivator for children. We propose that when children who have difficulty getting sufficient sleep see their friends and peers perform better than them in the star chart reward system, they will want to achieve healthier sleep habits.

It is also important to consider parents' attitudes towards sleep because they dictate the daily habits of their children. Each term, an information session will be held for parents of each year group to give scientific background as well as relevant guidance and ideas. It is critical that parents and instructors keep open lines of contact in order to discuss and offer feedback on their children's growth.

To motivate students to make this important change, students will be allowed to watch a movie or have extra playtime as a reward. By rewarding students for performing good behaviour, it improves their self-efficacy and belief that they are able to achieve positive health outcomes pertaining to sleep.

Outcomes

We predict that our Lights Out campaign will have various outcomes as the project expands. A two-stage intervention will be executed; the campaign will be designed to modify childrens pre-existing beliefs and subsequently affect their intentions, ultimately leading to the desired outcome which is change in their sleep behaviour. I will also address the potential future directions and limitations of our intervention.

As we plan to implement both an initial plan and a long-term strategy, the two levels of potential intervention will have an initial impact and a consequent impact.

For the first level, the campaigns use of posters, guides, and information sessions is expected to lead to changed perspectives in both school children and their parents. The expected outcome is that after the target population has received education about the importance of sleep hygiene, they will develop new attitudes and beliefs towards sleep hygiene. The information provided to the participants will be effective in raising awareness and changing the overall consensus of healthy sleep hygiene practices, while dissuading them from screen usage. To test this, questionnaires on opinions regarding sleep will be completed by a sample of 200 participants 6 months before and 6 months after the intervention. Reports from parents and progress-tracking apps will also be used to monitor sleep routines.

Once students have adopted the suggested practical strategies, the project will proceed to the second stage. As the campaign expands and incorporates sponsorship marketing, it is predicted that the various motivational tactics will strengthen the message of the intervention during the second stage. The expected outcome is that behavioural intentions will be targeted, ultimately achieving the desired behaviour change. Essentially, this stage of the intervention is predicted to socially motivate children to break poor sleep habits and subsequently influence their nightly routine. This impact will be measured through self-report surveys completed by the same sample, in addition to the progress-tracking apps.

Broader Implications & Health Contributions

The interventions broader implications are that the participating school children will no longer suffer from poor sleep hygiene, and in turn, the detrimental impacts of sleep practices such as social media use. With the application of the Theory of Planned Behaviour model, the intervention will make a significant improvement in childrens health and social behaviours. As such, the project will positively contribute towards the health and well-being of our target population while promoting self-care behaviours and healthy lifestyle practices over the long term.

Limitations

While we have designed our project to be realistic and feasible, certain limitations still exist.

A notable limitation of the intervention is the use of sleep-tracking technology; while sleep-tracking apps apps greatly benefit users, studies have shown various technical errors, malfunction and inconsistent data due to a sensitivity to movement (reference)

Moreover, health research has indicated that there may actually be a risk of heightened anxiety and insomnia as it may create a fixation on sleep onset and duration (Robbins et al., 2019).

Another limitation would be the interventions reliance on self-reported data through sleep-tracking technology and reports; while these measures provide a participant-focused evaluation, additional sources and methods may improve the interventions base of information.

References

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HEALTH PSYCHOLOGY ASSIGNMENT MARKING CRITERIA

Background/Rationale (20 marks)

Clearly describe and justify the topic (behaviour) and the target group

Justify the approach used (i.e., Why this model? Does the model identify the problems?)

Description/Plan (20 marks)

Clear description of the project and planned materials and activities

Plan clearly linked to the theoretical framework chosen

Discuss the feasibility of the plan and any ethical considerations

Outcome (10 marks)

Expected outcomes

How you would assess the effectiveness of the intervention

Reflection (20 marks)

Reflect on your experience developing your project/intervention, e.g.

What did you learn?

Reflect on approach, e.g., Did the theory/model fit with the project?

Reflect on the chances of success for your plan

Reflect on challenges faced in developing your plan, or potential challenges of implementing your intervention

What would you do differently next time, and why?

How could the intervention/change be sustained long term?

What additional factors could have been considered?

What would the intervention look like if a different model was used?

Writing style and structure (20 marks)

How well was the paper written?

How well structured was it?

Were the references and citations in APA style?

Was the paper substantially over the word count?

Creativity (10 marks- the same mark for all group members)

How original was the topic?

How creative were materials and activities designed?