Stakeholder perspectives on managing the adolescent sleep crisis using a transdiagnostic self-management app for sleep disturbances: A qualitative follow-up study

Clin Child Psychol Psychiatry. 2024 Sep 13:13591045241285586. doi: 10.1177/13591045241285586. Online ahead of print.

Abstract

Sleep problems are diverse and pervasive among the adolescent population. Current sleep health interventions are ill-equipped to address the sleep crisis. We developed DOZE (Delivering Online Zzz's with Empirical Support), which is a self-management evidence-based app for sleep disturbances. In an initial study, we found that DOZE was perceived as an acceptable and effective support for teen sleep. In a qualitative follow-up study, we engaged with students and other stakeholders to understand their experiences with implementing, disseminating, and using DOZE. The study employed a combination of qualitative surveys and semi-structured interviews to students (n = 21) and stakeholders (teachers, social workers, and researchers; n = 5), respectively. Reflexive thematic analysis was used to identify themes related to experiences implementing and engaging with the app. Students reported increased sleep regularity and sleep duration after using DOZE. Facilitators included greater integration of the app with school curriculum, timing of implementation, and researcher involvement in supporting knowledge dissemination and engagement. Barriers included worries about phone use at night and normalized poor sleep patterns among adolescents. There is need to identify ways to support implementation and engagement in different communities. Researchers continue to engage with stakeholders to support timely access to sleep health interventions for adolescents.

Keywords: Sleep health; evidence-based intervention; reflexive thematic analysis; teen sleep.

Plain language summary

High school students struggle with many sleep problems, which then causes problems in their health and ability to do well in school. However, regular solutions to improving sleep in teens ask them to go bed early, which is not helpful because teens tend to be 'night-owls'. To tackle this problem, we developed a teen sleep app based on sleep science (DOZE) that is free and accessible for high school students to use. We found that students found this app to be enjoyable to use and helpful in supporting sleep health. Our next step was to use survey questions and interviews to learn more from teachers, social workers, and students about their experience getting DOZE into the school and experiences using the app. We wanted to know what individuals liked about the app, what made it easier/harder to bring DOZE into the school, and how we can continue to support sleep health in adolescents. We found that students were more likely to use DOZE when the app was placed within the school curriculum (e.g., physical education courses) and when the researchers were more involved - such as by giving talks. On the other hand, some individuals were worried about the use of phones during the night time and some students figured that poor sleep is a normal part of the high school experience. Overall, individuals generally found DOZE to be helpful and social workers noted that they will continue to suggest DOZE for students that struggle with poor sleep. In terms of policy recommendations, we need to continue thinking about ways to support sleep health, such as by delaying school start times to give adolescents more time to sleep. We continue to work with teachers and social workers in Canadian high schools to understand how to support teen sleep.