Sleep Hygiene study

Introduction

The purpose of this research study is to describe the sleep hygiene practices of healthy, urban, minority school children ages 6-12 years old in the Bronx from the perspective of parents/caregivers.

Methodology

Study Design

A qualitative design was used for this study, using focus group discussions. Participants completed a demographic questionnaire and responded to a series of open-ended questions regarding their perceptions of their school –aged child’s sleep practices. Each focus group lasted for 45 minutes. The demographic questionnaires were completed individually by participants.

The focus group was conducted according to a modified nominal group technique for collecting group data.

The study utilized a convenience sampling strategy for parents/caregivers of school-aged children between the ages of 6-12 years old who attends either PS55 or Success Academy Bronx 2 and are enrolled in the Montefiore School Health Program (MSHP). The participants were recruited during open school day/night events at the elementary school and during clinical or administrative visits to the school-based clinic; an oral script was used to explain the research. Volunteering parents/caregivers were asked to supply their name and telephone number for further contact.

The participants were from 5-8 parents/caregivers per focus group. A total of 7 groups were held to produce an adequate sample size. Inclusion criteria: Parents/caregivers will be considered eligible a) if they are over age 21, b) are able to read, write and speak English, c) are the parents or caregivers of a child between the ages of 6-12 years old who attends either PS55 or Success Academy Bronx 2 and are enrolled in the MSHP. Exclusion criterion: Parents/caregivers, who cannot read, write or speak English.

Description of the Setting

This study was implemented at the Montefiore School Health Program (MSHP). The MSHP is the largest school-based health program of its kind in the country-currently there are 21 clinics in the program; the clinics are located in high schools, middle schools, and elementary schools. The MSHP is composed of four divisions: medical, mental health, dental and community health. The medical division of the program provides comprehensive medical care for the children and adolescents enrolled in the program which includes annual health assessments, referrals, school/camp/working paper physicals, reproductive care/family planning, asthma care, immunizations, and acute/episodic visits.

The MSHP at PS 55/SAB2 is located in the South Bronx and the majority of residents in the area are of African, African American/Black, Puerto Rican or Dominican descent.

The 45 minute session was held in the MSHP clinic between the hours of 3:30 – 4:15 pm. The location of the clinic in the school helped to keep transportation costs down since most of the families live within 1- 2 blocks of the school, the school building also remains open until 7 pm daily. For those parents who have children in afterschool, the locale removed the need for babysitting fees. The clinic has a large all purpose room that can accommodate the sample size, light refreshments were served.

Institutional Review Board approval and protection of human subjects

Institutional Review Board (IRB) approval for the study was granted by the Medical Center and Fairleigh Dickinson University (FDU). Each participant was asked to complete an informed consent prior to the commencement of the focus group.

Data collection

Once consent forms and demographic questionnaires were collected and reviewed for completeness the focus group interview began. A list of the focus group questions is found in Table 2. The written material was collected at the end of the group. The written material was stored in locked files before and after being analyzed and will be destroyed within 3 years after the completion of this study.

Data Analysis

A descriptive phenomenological research strategy was undertaken for this study. Descriptive frequencies was used for focus group participant demographics and summarized on Table 1. The raw data from all 7 focus groups was transcribed and combined from all participants in all groups and organized into themes by the investigator. Another seasoned nursing researcher reviewed the theme. The meanings of the themes were stated in a narrative form.

Discussion

Parents/caregivers in the study initially thought that the focus group was a workshop for them to learn about sleep and their school age children. They saw the moderator/facilitator as an important source of data about sleep and they were very surprised that the focus group was designed to learn about their sleep knowledge. In fact many of the parents/caregivers voiced that they have never been asked about sleep and their school age children outside of what time the child went to bed and what are the child’s sleep accommodations.

In addition many of the parents/caregivers wanted reassurance that their described actions where correct for their children’s sleep and many parents were very happy to hear that their ideas/ practices mirrored others in the groups. Several times the moderator/facilitator had to remind the focus groups that here were no right or wrong answers or responses to the open ended questions.

The study also provided new insight about urban, minority parents/caregivers knowledge of appropriate sleep practices. Many of the parents/caregivers whose’ education level is less than 8th grade, in fact more than a 1/3 of the parents/ caregivers are taking literacy classes twice weekly at the school. These same participants answered or responded to the questions with some of the same practices and techniques that the experts in sleep and children recommend in the literature. Parents/caregivers based their answers on the practices that have worked for them such as going to bed early, warm drinks, shutting off the TV. They also related how sleep helps and the effects of not sleeping well in terms of subjective and objective observations such as: poor focus to more focused, no energy, tired, falling asleep in class to-more energy, not healthy, weak, burned out, sick, poor growth to helps growth, helps body heal, helps body rest, and bad attitude, cranky, agitated, rude behavior to improves behavior or better behavior.

Limitations and Strengths

The researcher noted limitations related to the collection of the qualitative data obtained using the nominal group technique focus groups. More than 1/3 of the parent/ caregivers had less than 8th grade education. Many could not write their ideas down on the index cards as instructed because they could not spell. The focus group consensus may have inhibited those individuals who felt embarrassed by their educational level. Timeframe was not the best for many of the parents/caregivers because of diverse schedules. To meet sample size required recruitment had to go on longer and the number of focus groups had to be extended.

The strengths of the study are numerous including those that were not directly related to the study particularly empowerment and trust. As stated previously many of the participants have less than an 8th grade education. Several of the mothers who fell into this category revealed that their education was even less than 2nd grade and that culturally their opinions are not valued and so participation in such an event was an accomplishment. In addition the trust to give out the demographic information was also a strength for a community that does not trust easily.

Recommendations

Based on the findings of the focus groups there should be a school wide parental/caregiver survey of sleep practices to produce quantitative data for future studies. More research is needed to examine how parents can implement the sleep practices that they have described in the focus groups especially with a household size of 5-6 people and an income of less than $15,000 as shown in demographic data. Understanding parent/caregiver perception of sleep is an important aspect of assessing the quality of sleep that urban, minority school children are having, especially in light of previous studies that found that parents/caregivers have a lack of knowledge.

This study provides a view of what some parents/caregivers perceive as healthy sleep practices for school age children. As nurses we are in a strategic position to support parents/caregivers in the accurate perceptions of what constitutes healthy sleep practices for their children. We can use this information to develop interventions on sleep hygiene practices for school age children that builds upon what is already known by their parents/caregivers.

Age/ Gender/Marital Status a
 Parent/Caregiver (n = 36)
 Percentage
 Child (n = 48)
Relationship  to  child
   Mother
32
88.88
   Grandmother
2
5.55
   Adoptive Parent
1
2.77
   Other Relative
1
2.77
Education Level
   Less than 8th grade
12
33.33
   Some high school
4
11.11
   High school  graduate
8
22.22
   Some college
8
22.22
   College graduate
4
11.11
Family Income
 >$50,000
2
5.55
$45,000 to $49,000
2
5.55
$35,000  to $40,000
3
8.33
$25,000  to $30,000
2
5.55
$15,999  to $20,000
5
13.88
Less  than  $15,000
13
36.11
Did not respond
9
25
 Number of Persons  in the  home  b
  3-4
9
25
  5-6
15
41.66
  7-8
11
30.55
  9-10
1
2.77
 Child’s Age Group c
   4-5
2.08
1
   5-6
18.75
9
   7-8
20.83
10
   9-10
39.58
19
   11-12
18.75
9
 Child’s Gender    d
    Female
50
24
    Male
50
24
Current grade in school
 6th
6.25
3
 5th
10.4
5
 4th
35.41
17
 3rd
10.4
5
 2nd
12.5
6
 1st
10.4
5
 Kindergarten
10.4
5
 Pre-Kindergarten
4.166
2

Table 2.
Focus Group Questions Guiding Data Collection

  1. How does sleep help a child‘s health?
  2. What are some reasons that interfere with a child’s sleep?
  3. What are some effects of a child not sleeping well?
  4. What are some strategies to help a child sleep?

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