Evaluation of a sleep education program for low-income preschool children and their families

Abstract

Study objectives: To evaluate a novel sleep education program for low-income preschool children and their families.

Design: Randomized trial of an educational intervention.

Setting: Community-based.

Participants: Head Start preschool families (n = 152) in greater Lansing and Detroit, Michigan.

Interventions: Classrooms or Head Start sites were randomized to an intervention group (prompt intervention) versus a control group (delayed intervention). Parents attended a one-time, 45-min sleep education program and preschoolers received 2 w (320 total min) of classroom sleep curriculum.

Measurements: Parent knowledge, attitudes, self-efficacy, and beliefs were assessed as the primary outcomes just before the 45-min sleep intervention, immediately postintervention, and approximately 1 mo postintervention. Parents reported their child's bedtimes and wake times on 7-day sleep diaries at baseline and at 1-mo follow-up. Average weeknight sleep durations and bedtimes served as secondary outcomes.

Results: Linear mixed models showed a time × treatment effect for parents' knowledge, attitudes, and self-efficacy (each P < 0.05) but not beliefs. These improvements were found immediately postintervention but were not retained at 1-mo follow-up. Children in the intervention group improved their weeknight sleep duration at 1-mo follow-up by 30 min (11.0 ± 0.9 h vs. 10.5 ± 1.0 hours at baseline) compared to controls (10.4 ± 0.9 h versus 10.5 ± 0.9 h at baseline) (P = 0.04 for difference between groups). Children did not show statistically significant improvements in bedtime.

Conclusions: Educational interventions in early childhood can have an effect on parents' sleep knowledge, attitudes, and self-efficacy, and on children's sleep behavior. However, repeated exposure to the new information may be important for parents as well as their children.

Keywords: bedtimes; curriculum; education; health behavior; intervention; preschool children; sleep; sleep duration; socioeconomic status.

Figures

Figure 1

Study design for this randomized controlled assessment of a new sleep education program.

Figure 2

The least means squares with Bonferroni adjustment in linear mixed models, adjusted for child race/ethnicity and maternal education, are plotted for: (A) knowledge; (B) attitudes; (C) self-efficacy; and (D) beliefs. In the intervention group, each subscale score improved from pre-intervention (time 1) to postintervention (time 2), but not from postintervention (time 2) to follow-up (time 3) or preintervention (time 1) to follow-up (time 3) (significant P values are shown). No significant improvement in scores occurred for the control group. In the overall linear mixed models, adjusted for child race/ethnicity and maternal education, a significant time × treatment interaction emerged for self-efficacy (P = 0.02), attitudes (P = 0.001), and knowledge (P = 0.02), but not for beliefs (P = 0.20).

Figure 3

Average weeknight sleep duration for the intervention and control group at baseline and 1-mo follow-up. Using a 2 × 2 analysis of variance, a significant time × treatment interaction emerged (P = 0.04). Plots show medians, means (diamonds), 25th and 75th percentiles, 10th and 90th percentiles (serifs), and outliers.

Figure 4

Average weeknight bedtime for the intervention and control group at baseline and 1-mo follow-up. Using a 2 × 2 analysis of variance, no significant time × treatment interaction emerged (P = 0.12). Plots show medians, means (diamonds), 25th and 75th percentiles, 10th and 90th percentiles (serifs), and outliers.