A USER-CENTERED APPROACH IN THE DEVELOPMENT OF AN EHEALTH SLEEP INTERVENTION FOR ADOLESCENTS WITH AND WITHOUT RECURRENT PAIN

Abstract

Healthy sleep is critical for adolescents’ functioning. However, 25% of adolescents report sleeping less than the recommended 8-10 hours a night. Sleep and recurrent pain often occur together in adolescents, both negatively influencing functioning. While in-person adolescent sleep interventions are effective, several barriers impact access to treatment (e.g., clinician availability). The delivery of eHealth interventions has potential to improve access to evidence-based sleep treatment. The primary objective of this dissertation was to follow a user-centered approach in developing an eHealth sleep intervention for adolescents with and without recurrent pain. This dissertation consists of three studies: 1) focus group testing, 2) usability testing, and 3) pilot testing of an eHealth sleep intervention. Through online focus groups, opinions were gathered from adolescents (with and without recurrent pain) and stakeholders (parents, educators, health care professionals) about adolescents’ use of healthy sleep practices and eHealth sleep intervention. Most healthy sleep practices were considered reasonable for adolescents to implement. However, many barriers to sleep practices were identified. Interactive features were desirable for an eHealth sleep intervention. Participants reported that a program appearing too educational was a barrier, while accessibility was a common facilitator. Most discussions were consistent across groups. Feedback from the focus groups was incorporated into development of Better Nights, Better Days – Youth (BNBD-Youth). Usability testing of BNBD-Youth revealed that the program was positively received for meeting adolescents’ needs, with high overall ratings for usability. Minor modifications to the program based on suggestions from user feedback are recommended. Pilot testing of BNBD-Youth achieved high rates of participant retention, pre-post data collection, and diary completion. Further, BNBD-Youth led to significant improvement across several post-intervention sleep, daytime functioning, and pain outcomes. Finally, these results identified that a small-moderate effect size was needed to demonstrate significant change in sleep efficacy for future RCT testing. Results of these studies support following a user-centered approach in developing and testing an eHealth sleep intervention for adolescents with and without recurrent pain. These findings are encouraging for larger-scale testing and implementation of BNBD-Youth with the goal of increasing adolescents’ accessibility to evidence-based treatment and improving sleep and daytime functioning.