The ABCs of SLEEPING: Effectiveness Study

An evidence-based approach to treating sleep problems in school-aged children is to follow a stepped approach where interventions more easily implemented with fewer side effects (i.e., psychoeducation and implementing healthy sleep practices) are implemented first, followed by more involved approaches (i.e., behavioural intervention), and only using those with potential side effects as a final approach (i.e., medication). While there have been interventions developed for all of the above noted approaches, there are practical barriers (e.g., time and cost) as well as system barriers (e.g., healthcare professionals reporting a lack of training, knowledge, and time to provide evidence-based sleep care). Together, these barriers impact the ability of parents to access sleep intervention within this stepped approach. Given the high prevalence of internet use in North America, there is a growing trend for interventions to be adapted to online formats which addresses these accessibility barriers so that these interventions can reach most families with access to the internet. A smartphone app-based mode of intervention delivery is useful for accessibility and convenience reasons (e.g., no time cost for attending program/intervention sessions for busy parents, cost-effectiveness, etc.). Additionally, delivering sleep intervention via a smartphone app has the strong potential for effectiveness as they are delivered in a home setting (i.e., where new intervention practices are to occur). The investigator's research team has developed a smartphone app intervention called "ABCs of SLEEPING" which was initially developed to be a mnemonic to draw attention to the important factors that must be considered for healthy sleep practices for children: 1) age-appropriate bedtimes and wake-times with consistency, 2) schedules and routines, 3) location, 4) no electronics in the bedroom or before bed, 5) exercise and diet, 6) positivity, 7) independence when falling asleep, and 8) needs met during the day, 9) equal great sleep. The ABCs intervention includes three components. The first component is the ABCs of SLEEPING questionnaire that assesses the child's sleep practices using parent's responses to questions within each of the ABCs of SLEEPING healthy sleep practice areas. These responses algorithmically determine the feedback received on the second component, the sleep report card, which provides parents with feedback on each healthy sleep practice area. Feedback is provided based on a star system, with one star denoting the sleep practice area to be high priority (i.e., the healthy sleep practice recommendations are not being met), two stars denoting medium priority (i.e., the healthy sleep practice recommendations are not being fully met), and three stars denoting low priority (i.e., the healthy sleep practice recommendations are being fully met). The third component, the sleep tips, are then organized for the user in terms of priority. Priority is based on the star system described above, in combination with the robustness of the evidence for the healthy sleep recommendation. For example, if one star was received for both use of electronics at night and exercising prior to bed, use of electronics would be prioritized over exercising before bed based on the strength of the extant literature for this recommendation. To date, the ABCs of SLEEPING intervention has undergone evaluation in terms of its usability (i.e., usability, usefulness, desirability, etc.) and feasibility (i.e., acceptability, implementation, and preliminary efficacy). The next step in this research is to evaluate the ABCs of SLEEPING intervention for its effectiveness using increasing control (i.e., a control group and controlling for variables like sleep medication).

This effectiveness trial will be composed of three study periods. The first period is the "pre-test" period where baseline measures of the Children's Sleep Habits Questionnaire, Pediatric Insomnia Severity Index, Bedtime Routines Questionnaire, Actigraph/Sleep Diary, as well as demographics (i.e., measured using a Demographics Questionnaire) are collected. Following this pre-test period, parents will be randomized to either to the treatment or the control group. Parents randomized to the treatment group will receive the ABCs of SLEEPING intervention for a 4-week period. Parents in the intervention group will no longer have access to the intervention after this 4-week period concludes. Parents in the control group are not required to complete any study measures during this time period. Following this "intervention period" is the "post-test" period. During the post-test period, parents will complete again the study's measures (i.e., The Children's Sleep Habits Questionnaire, Pediatric Insomnia Severity Index, Bedtime Routines Questionnaire, and Actigraph/Sleep Diary). After completing the post-test period, the study will conclude. Additionally, parents in the control group will receive the intervention for a 4-week period.