Impact of an Online Sleep and Circadian Education Program on University Students’ Sleep Knowledge, Attitudes, and Behaviours

Abstract

University students consistently report poor sleep. We conducted a before-and-after study to evaluate the impact of an online 10-week course on undergraduate students’ sleep knowledge, attitudes, and behaviours at 6-month follow-up. Data were collected via baseline course surveys (August–September 2020) and follow-up surveys distributed via email (February–March 2021). n = 212 students completed baseline surveys and n = 75 (35%) completed follow-up. Students retained to follow-up possessed higher baseline sleep knowledge and received higher course grades. At the 6-month follow-up, sleep knowledge had increased (mean score out of 5: 3.0 vs. 4.2, p < 0.001). At baseline, 85% of students aimed to increase their sleep knowledge and 83% aimed to improve their sleep. At follow-up, 91% reported being more knowledgeable and 37% reported improved sleep. A novel Stages of Change item revealed that 53% of students’ attitudes towards their sleep behaviours had changed from baseline. There was a reduction in sleep latency at follow-up (mean 33.3 vs. 25.6 min, p = 0.015), but no change in the total Pittsburgh Sleep Quality Index score. In summary, completion of an online course led to increased sleep and circadian knowledge and changed sleep attitudes, with no meaningful change in sleep behaviours. Future interventions should consider components of behavioural change that go beyond the knowledge–attitudes–behaviour continuum.

The Impact of an Online Sleep Education Program (Sleep 101) on Sleep Hygiene and Sleep Behavior in College Students<strong> </strong>

“…This study explored the effects of a sleep education program (Sleep 101) on college students' sleep behavior and sleep hygiene. First, the proportion of college students who received sleep education before participating in Sleep 101 was smaller in our sample (3.6%) compared to an earlier study (Semsarian et al, 2021), where one-third of students already had prior knowledge. Although the majority of our sample was satisfied with their sleep quality, 37.9% of participants indicated poor sleep quality, which again supports literature (Brown et al, 2002) highlighting the importance of sleep promotion and emphasizing the need for educational programs to improve students' sleep.…”

A Circadian Hygiene Education Initiative Covering the Pre-pandemic and Pandemic Period Resulted in Earlier Get-Up Times in Italian University Students: An Ecological Study

“…2 However, completion of questionnaires/compliance decreased considerably over time, suggesting feasibility issues with the initiative recall/refresh frequency, which may need modulating. It should be highlighted, however, that our intervention, lasting 1 year and based on monthly monitoring, was much longer and included considerably more time points than the few published similar interventions ( Hershner and O’Brien, 2018 ; Illingworth et al, 2020 ; van Rijn et al, 2020 ; Semsarian et al, 2021 ). For example, Semsarian et al (2021) report 35% participation on second contact; ours was similar, with 32% of students responding at T1 ( Supplementary Table 1 ).…”

“…It should be highlighted, however, that our intervention, lasting 1 year and based on monthly monitoring, was much longer and included considerably more time points than the few published similar interventions ( Hershner and O’Brien, 2018 ; Illingworth et al, 2020 ; van Rijn et al, 2020 ; Semsarian et al, 2021 ). For example, Semsarian et al (2021) report 35% participation on second contact; ours was similar, with 32% of students responding at T1 ( Supplementary Table 1 ). In addition, lower completion rates after T0 do not necessarily imply lack of compliance with the advice received on joining the initiative.…”

“…The published, original, and also review/meta-analytic literature on education (mostly sleep but also circadian) aimed at adolescents ( Chung et al, 2017 ; Illingworth et al, 2020 ; van Rijn et al, 2020 ) or university students ( Dietrich et al, 2016 ; Hershner and O’Brien, 2018 ; Semsarian et al, 2021 ) is not conclusive; it is based on shorter programs, yielding generally short-lived effects. In addition, it suggests that more consistent interventions compared with ours in terms of provision of information on the science/medical evidence behind the advice delivered tend to result in increased knowledge but not necessarily in significant changes in sleep/circadian habits ( Illingworth et al, 2020 ; van Rijn et al, 2020 ).…”

Feasibility of a Circadian Lighting Intervention to Promote Sleep in College Students

“…Efforts to promote sleep in college students have focused on sleep hygiene with limited success in students with significant sleep deficits. Sleep education programs may increase sleep knowledge and attitudes but tend not to improve sleep behaviors or quality of sleep (Semsarian et al, 2021).…”