Challenges in implementing and assessing outcomes of school start time change in the UK: experience of the Oxford Teensleep study

Abstract

Objective Later school start times for adolescents have been implemented in the US and associated benefits found, although no randomised controlled trials (RCT) have been undertaken. The objective of this study was to evaluate the impact of two school interventions in the UK, a delayed start time and a sleep education programme, on students’ academic performance, sleep outcomes and health-related quality of life. Methods The study had an RCT design to enable an investigation into the differential effects of two interventions or a combination of both: schools were to delay their start time to 10:00am and/or provide a classroom-based sleep education programme. The recruitment target was 100 state (non-fee-paying) secondary schools. Participants were to be students in Year 10/11 (14–16-year-olds). Results Despite much media coverage, only two schools volunteered to take part in the RCT. The main challenges faced in recruitment fell under three categories: research design, school, and project-specific issues. The delayed start time and prospect of randomisation to this intervention were the overwhelming reasons cited for not taking part. Facilitators and barriers to research were identified. Recommendations include carrying out a feasibility study prior to a main trial, allowing adequate time for recruitment, involving stakeholders throughout the decision-making process, incorporating independent (fee-paying) schools in recruitment, focusing on students not taking important examinations or involving an older year group with greater independence. Conclusion The Teensleep study provides supporting evidence that evaluating the effects of a change in school start times through an RCT is unfeasible in the UK.

Later School Start Time: The Impact of Sleep on Academic Performance and Health in the Adolescent Population

“…Although these programs are effective and useful in raising subjective awareness, their exclusive application has scarce and low effects on adolescent behavior [136]. As a possible solution, the combined application of sleep hygiene and delayed start times programs [137,138] could represent an effective solution in addressing adolescents' sleep problems by increasing individual motivation and providing a concrete countermeasure to short sleep duration.…”

The challenges of adolescent sleep

“…In recognition of the insufficient sleep experienced by adolescents and the importance of sleep for functioning and health, school-based initiatives at the organizational and classroom level need implementing. Our Teensleep research group has developed and evaluated such an initiative in an effort to improve adolescent sleep in the UK [71,72]. This work follows in the footsteps of sleep education interventions introduced worldwide: for example, in the USA [73], Australia [74,75] and Asia [76].…”

Translation and Validation of a Chinese Version of the Cleveland Adolescent Sleepiness Questionnaire

“…The CASQ had been widely used in the area of sleep medicine, children's health care, nursing research, and psychology and education. [35][36][37][38] The purpose of this work was to translate, adapt, and evaluate the psychometric properties of a Chinese version of the CASQ (C-CASQ) [see Additional File 1] using a sample of adolescents from Taiwan. We found that the C-CASQ had good psychometric properties and was consistent in measuring sleepiness differences in morning and evening chronotypes.…”