Feasibility and Preliminary Efficacy of an m-Health Intervention Targeting Physical Activity, Diet, and Sleep Quality in Shift-Workers

Abstract

Poor health behaviors are prevalent in shift-workers, but few multiple health-behavior interventions consider their unique needs. This study aimed to (1) evaluate the feasibility and acceptability of an existing app-based intervention to improve physical activity, diet, and sleep quality in a shift-worker population, (2) estimate intervention effect in a four-week pilot randomized controlled trial (RCT) (ACTRN12618001785291). Shift-workers (18–65 years old) were randomized to intervention (n = 20) or wait-list (n = 20) groups. Outcomes included recruitment, engagement, attrition, usefulness ratings, System Usability Scale (SUS), qualitative interviews, and estimation of treatment effect (minutes of physical activity, diet quality, and sleep quality) using mixed model analysis. Recruitment took one week. App-use at week four was 55% (11/20), 85% (34/40) completed the four-week follow-up questionnaire, and 20% (4/20) of the intervention group completed the qualitative interview. The intervention was rated as slightly to moderately useful by 76.9% (10/13) of participants on a five-point scale. The SUS score was 62.7 (12.7) out of 100. Diet quality improved for the intervention (4.5 points; 95% confidence interval (CI) = 0.1, 8.9; p = 0.047) vs. the wait-list group, but not physical activity or sleep quality. Qualitative interviews found that a more tailored intervention, more accessible information, and interactive features were desired. The intervention was feasible in terms of recruitment, but modifications to increase engagement are needed.

Sleep, diet, activity, and incident poor self-rated health: A population-based cohort study.

“…A study that examined change over time found that maintaining or increasing moderate-intensity physical activity was associated with less decline in SRH (Sargent-Cox et al, 2014). Our understanding of associations between health behaviors and SRH is therefore primarily limited to cross-sectional associations (Conry et al, 2011; Dalmases et al, 2019; Duncan et al, 2014; Harrington et al, 2010; Oftedal, Kolt, et al, 2019; Riediger et al, 2019; Rosenkranz et al, 2013; Tsai et al, 2010).…”

“…Specific patterns of health behaviors have different effects on mortality risk, and patterns characterized by lower levels of physical activity, prolonged sitting, and/or long sleep duration have been shown to have the strongest associations with all-cause mortality (Ding et al, 2015). Behavioral patterns may also be important to SRH, and while evidence from prospective studies is limited, cross-sectional studies report that behavior patterns characterized by multiple high-risk health behaviors are associated with poorer SRH and mental health (Conry et al, 2011; Oftedal, Kolt, et al, 2019). A few studies have explored prospective associations between behavior patterns and HRQoL, but findings are mixed, ranging from significant associations between patterns of physical activity level and sedentary behavior and HRQoL (Guallar-Castillón et al, 2014) to nonsignificant associations between patterns of alcohol consumption, physical activity level, diet quality, and smoking and HRQoL (Rabel et al, 2019).…”

Sleep and Wellbeing, Now and in the Future

“…Sleep medicine has come a long way due to increased public awareness, as highlighted by the study of Savic et al (2019), who reported that the nurses in their study had already adopted health-promoting coping strategies with their night shifts [32], including health practices of physical activity, healthy eating, engaging with social support and leisure, mindfulness, managing time, and work-related coping strategies. Nevertheless, the online platforms of mHealth [33] and cognitive behavioural therapy for insomnia (CBTi) [34] are resourceful, easily accessible materials for shift workers. Forest therapy (originating in the 1980s in Japan for stress reduction) that improved sleep efficiency in cancer patients [35] may be explored in shift workers in future studies.…”

Effectiveness of a Mobile Wellness Program for Nurses with Rotating Shifts during COVID-19 Pandemic: A Pilot Cluster-Randomized Trial

“…Systematic reviews of adults with sleep problems and individuals across their lifespan have shown that both long-term and acute bouts of physical activity positively affect sleep [ 10 , 11 ]. A few studies on the relationships between physical activity and sleep for shift workers have demonstrated that physical activity programs for shift workers improved their quality of sleep, including their sleep efficiency and sleep latency [ 12 ]. Nurses are unlikely to participate in physical activity programs provided by institutions or public health centers due to poor work environments with irregular shifts, night shifts, and long working hours.…”

“…Mobile health technology, including wearable activity trackers and smartwatches, might effectively engage shift workers in wellness programs [ 12 ]. Since the COVID-19 pandemic has caused us to adjust to life indoors, efforts to reduce the spread of the virus have forced people to adapt to online exercise using Zoom, Instagram, and YouTube [ 14 ].…”