Beliefs about Healthy Sleep Habits in Adults with Diabetes Compared to Adults without Diabetes: A Reasoned Action Approach Elicitation Study

Abstract

Objective Sleep is part of a healthy lifestyle and in adults with diabetes, inadequate sleep is associated with risks of developing complications. The objective was to compare beliefs about healthy sleep habits (HSHs) in adults with versus without diabetes based on the Reasoned Action Approach. Methods A total of 56 adults with and 98 without diabetes answered open-ended questions regarding their beliefs about: avoiding screen use in bed; having a regular sleep schedule; or avoiding caffeine, alcohol, and cigarettes before bedtime. A qualitative content analysis was used to identify the most important beliefs, similarities, and differences between both groups. Results Both groups reported that adopting HSHs could improve sleep. Having a regular sleep schedule was perceived to facilitate diabetes management in adults with diabetes. Negative consequences specific to adopting each HSH were identified in both groups. Adopting HSHs was associated with mainly negative emotions (e.g., stress, anxiety, fear) in both groups. Avoiding screen use in bed was associated with anxiety of not knowing blood glucose levels at night in adults with diabetes. Partners, parents, and friends were considered the most important individuals who would approve of adopting HSHs, but they were often perceived as unlikely to adopt HSHs themselves in both groups. Adults with diabetes perceived more barriers to adopting HSHs. Facilitating factors for both groups included removing triggers of unhealthy sleep habits, behavior substitution, using reminders, time management, and social support. Discussion These beliefs can guide the development of behavioral sleep interventions, including interventions specifically for adults with diabetes.

Psychosocial determinants of healthy sleep habits in adults with type 1 and type 2 diabetes

“…Sleep variability is associated with risk of T2D in adults (Rosique-Esteban et al, 2018 ), suggesting it might have an impact on glucose levels in adults with diabetes. As anticipated based on the results of our previous formative qualitative research (Vézina-Im et al, 2023 ), fewer adults with diabetes reported caffeine and alcohol consumption, and smoking cigarettes before bedtime. Similar numbers of adults with diabetes reported consuming caffeine (46.1%) and smoking cigarettes (8.6%) before bedtime compared with a study in which 45.0% and 9.2% of adults reported caffeine and nicotine consumption, respectively, before bedtime (Spadola et al, 2019 ).…”

“…This suggests that the adoption of this HSH is not easy as adults with diabetes are faced with many barriers to overcome, which was also reflected in the low mean score for PBC to avoid screen use in bed. In our previous pilot study, adults with diabetes reported more barriers than facilitating factors (5 vs 2) compared to adults without diabetes (2 vs 3) for avoiding screen use in bed (Vézina-Im et al, 2023 ). Habit of using screens in bed was another significant psychosocial determinant of screen use in bed.…”

“…The indirect measures (i.e. behavioral beliefs, normative beliefs and control beliefs [barriers and facilitating factors]) were formulated using the modal salient beliefs that were previously identified using a 75% cumulative frequency of mention criterion (Fishbein & Ajzen, 2010 ) in a formative qualitative research conducted among 56 adults with T1D and T2D (Vézina-Im et al, 2023 ) (see Electronic Supplementary Material 1 for the content of both questionnaires). Items were formulated in terms of avoiding screen use in bed and having sleep regularity (i.e.…”

“…context, time of the day, location) and imply adopting a behavior with a degree of automaticity or lack of awareness (Gardner & Rebar, 2019 ). Habits can predict the adoption of health behaviors (Gardner, 2015 ), including adolescents’ screen time (Aulbach et al, 2023 ), and screen use in bed represented an ingrained unhealthy habit in our previous formative qualitative research (Vézina-Im et al, 2023 ). Habit of using screens in bed was thus included as an additional variable in the present study.…”

“…A secondary objective is to document the HSH of avoiding caffeine, alcohol, and cigarettes before bedtime among adults with diabetes. In our previous pilot study among adults with T1D and T2D, 57.1% of them reported that avoiding screen use in bed and 32.1% that having sleep regularity were HSH they needed to improve, while only 10.7% mentioned this was the case for avoiding caffeine, alcohol, and cigarettes before bedtime (Vézina-Im et al, 2023 ).…”