Better Sleep, Better Health: Designing a school-based intervention in Uganda

该项目旨在制定一种可行和可接受的干预措施，以改善乌干达在校青少年的睡眠和心理健康。睡眠不佳在青春期很常见，并且与多种负面健康和学业后果有关1，2。在全球范围内，针对青少年的睡眠干预试验显示出对睡眠健康有效的初步证据3，但还需要更多的证据，包括解决来自低收入和中等收入国家（LMIC）的证据差距，以及对密切相关的结果（包括心理健康）的有效性4 - 6。随着越来越多的人认识到睡眠质量差的问题，7以及所有社会经济背景的学生中寄宿的比例很高，这增加了睡眠干预的潜在可行性和影响。由于我们在乌干达制定、提供和评估学校健康干预措施方面的经验，以及我们强大的利益相关者关系，我们有能力开展这项工作8，9。我们之前的工作包括最近完成的一项关于月经健康干预对乌干达60所中学3844名女学生心理健康症状影响的随机分组试验。总体而言，16.2%的参与者报告在基线时感到疲倦或前一天晚上睡眠有问题，这些问题与一年后增加的心理健康症状密切相关（根据基线心理健康进行调整）。来自41名教师的初步数据显示，学生普遍担心疲劳，并愿意通过共同开发和实施干预措施来改善睡眠健康。本研究旨在：第一阶段：通过了解乌干达中学睡眠的社会，文化和物理背景，以及学生中不同形式的睡眠问题的患病率，为早期干预措施的开发提供信息;第二阶段：共同开发基于理论的睡眠健康干预措施，以改善学校的睡眠健康，进而改善学校的心理健康;第三阶段：传播研究结果，并制定详细的计划，在未来的试验中评估干预措施。我们将通过参与式混合方法形成性研究和利益相关者参与研讨会来实现这些目标，具体如下：第一阶段：与利益攸关方的定性访谈（学生、教师、照顾者和决策者）、学校宿舍的参与性样带步行以及2所中学的定量调查（N=200名学生）了解睡眠的背景，失眠的患病率，昼夜节律紊乱，睡眠持续时间，时间和质量，阶段2a：利益相关者研讨会i）回顾睡眠健康干预如何改善青少年睡眠和心理健康的理论; ii）根据第一阶段的研究结果，共同开发一个计划理论和干预措施，以全校方式促进所有学生的睡眠健康（第一步），并为有睡眠问题的学生提供额外的针对性课程（第二步）第2b阶段：在2所学校进行可行性测试，以完善方案理论和干预措施，并举办利益攸关方研讨会，以根据这些研究结果商定进一步的调整。第3阶段：出版关于这一人群睡眠健康的研究结果、干预措施制定过程和修订后的方案理论，并向地方和国家利益攸关方传播。我们将准备一份详细的干预计划，并为未来的试验进行评估。这项研究将增加撒哈拉以南非洲和全球青少年睡眠健康方面的文献，并提供重要的形成性证据，以指导对基于理论的干预进行严格评估，并有可能大规模改善睡眠和心理健康。

This project aims to develop a feasible and acceptable intervention to improve sleep and mental health among in-school adolescents in Uganda. Poor sleep is common during adolescence, and is associated with multiple negative health and academic consequences1,2. Globally, trials of sleep interventions for adolescents show preliminary evidence of effectiveness on sleep health3, but more evidence is needed, including to address the evidence gap from low- and middle-income countries (LMICs) and on effectiveness on closely-related outcomes including mental health4-6.Uganda is an ideal setting to develop a school-based sleep intervention, with an increasingly-recognised problem of poor sleep quality7 and a high proportion of students of all socio-economic backgrounds who board, which increases the potential feasibility and impact of a sleep intervention. We are well-placed to conduct this work due to our experience in developing, delivering and evaluating school health interventions in Uganda, and our strong stakeholder relationships8,9. Our prior work includes a recently completed cluster-randomised trial of the effect of a menstrual health intervention on mental health symptoms among 3844 female students in 60 Ugandan secondary schools9. Overall, 16.2% of participants reported feeling tired or having problems sleeping the previous night at baseline, and these problems were strongly associated with increased mental health symptoms after one year (adjusted for baseline mental health). Preliminary data from 41 teachers showed widespread concern about tiredness in students and willingness to improve sleep health through co-developing and implementing interventions.This study aims to:Phase 1: Inform early-stage intervention development by understanding the social, cultural and physical contexts of sleep in Ugandan secondary schools, and the prevalence of different forms of sleep problems among students;Phase 2: Co-develop a theory-based sleep health intervention to improve sleep health and subsequently mental health in schools;Phase 3: Disseminate findings and prepare a detailed plan to evaluate the intervention in a future trial.We will achieve these aims using participatory mixed-methods formative research and stakeholder engagement workshops, specifically:Phase 1: Qualitative interviews with stakeholders (students, teachers, caregivers and policymakers), a participatory transect walk of school dormitories, and a quantitative survey in 2 secondary schools (N=200 students) to understand the context of sleep, and the prevalence of insomnia, circadian rhythm disturbances, sleep duration, timing and quality, and dysfunctional beliefs and attitudes about sleep.Phase 2a: Stakeholder workshops to i) review theory about how sleep health interventions improve adolescent sleep and mental health; ii) co-develop a programme theory and intervention for this context based on Phase 1 findings with a whole-school approach to promote sleep health in all students (Step 1) and additional targeted sessions for those with sleep problems (Step 2).Phase 2b: Feasibility testing in 2 schools to refine the programme theory and intervention, and stakeholder workshop to agree further adaptations based on these findings.Phase 3: Publications on the findings on sleep health in this population, the intervention development process and revised programme theory, and dissemination to local and national stakeholders. We will prepare a detailed plan for the intervention, and for a future trial to evaluate this.The study will add to the sparse literature on sleep health in sub-Saharan Africa and in adolescents globally, and provide vital formative evidence needed to inform a rigorous evaluation of a theory-based intervention with the potential to improve sleep and mental health at scale.