Sleep Health Literacy in Head Start
Condition: Sleep
Study type: Interventional

Summary: 
      Conduct Sleep Health Literacy RCT- Using a stepped wedge randomized design, investigators
      will enroll 540 parent-child dyads from 7 Head Start agencies in New York. Agencies
      cross-over from control to intervention. Outcomes are a) child sleep duration, b) parent
      knowledge, attitudes, self-efficacy and behavior, c) child sleep difficulty and d) classroom
      climate. Invesetigators will compare intervention vs. control data across agencies and
      pre/post data within agency, with parental health literacy as a moderator. Investigators will
      collect process and fidelity data.
    

Detailed description: 
      Abstract: Inadequate and/or poor quality sleep in early childhood impairs social-emotional
      and cognitive function (via effects on the developing brain), and markedly increases obesity
      risk (via hormonal and endocrine effects). Short sleep duration, behavioral sleep problems
      and sleep-disordered breathing peak at 20%-50%, during the preschool years (ages 3-5).
      Healthy sleep habits increase sleep duration and prevent behavioral sleep problems. Awareness
      of sleep-disordered breathing symptoms leads to timely treatment for it. Despite ample data
      on sleep problems "…much less work has been done on effective strategies to promote sleep as
      a healthy behavior (CDC 2013)". This study's overarching goal is to empower families of
      preschool children with the knowledge and skills needed for healthy sleep, and to recognize a
      sleep problem. It builds on work in Head Start, an early childhood education (ECE) program
      for disadvantaged preschool children and their families: The team's Early Childhood Sleep
      Education Program (ECSEP™) educates Head Start teachers, children, and parents about healthy
      sleep in a way they can process and understand. In a randomized controlled trial, the
      children in the ECSEP group slept 30 minutes longer/night. As well, our UCLA Health Care
      Institute's structured approach to low literacy health training in Head Start (to reduce ER
      visits, obesity, etc.) has reached >100,000 families. The proposed study will implement a
      Social-Ecological web of multi-level interventions to reinforce the ECSEP, and to promote
      healthy sleep throughout ECE. Within Head Start, the team will create new delivery platforms
      (print & video, family visits) that 'amplify' the ECSEP. Beyond Head Start, the team will
      educate communities, and partner with stakeholders on strategies designed to embed 'sleep
      health literacy' in ECE policy. This project will: 1) Adapt sleep education material into
      additional multi-media formats, and; apply the Health Care Institute model to train Head
      Start staff to mount interventions and collect data. 2) Enroll 540 parent-child dyads from 7
      Head Start agencies in New York in a stepped wedge randomized controlled trial. Investigators
      will analyze trial effects on primary outcomes: a) child sleep duration, b) parent knowledge,
      attitudes, self-efficacy and behavior, and c) child sleep difficulties. 3) Assess the
      feasibility of screening and guidance for sleep problems (vs. sleep health) for a future
      efficacy study. Secondary outcomes are: classroom behaviors, policy change, and process data.
      Poor sleep in early development has ramifications for years to come, perhaps through
      adulthood. Head Start serves low-income, mainly racial-ethnic minority families, in whom
      sleep health disparities are greatest-- but are modifiable. This study joins together proven
      methods of delivering health literacy (Health Care Institute) and sleep health (ECSEP)
      programs in Head Start. Intervening at every level of the Social-Ecological model maximizes
      the study's reach and sustainability. Integrating sleep health literacy into ECE nationwide
      could ultimately benefit upwards of 4 million children. The potential impact upon human
      health is far-reaching.
    

Intervention name(s): Sleep Health Education
Intervention type(s): Other
Intervention description(s): Parents and children receive sleep health education
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Stepped wedge cluster RCT Participating agencies (n=7) were randomly assigned to 'wedge 1' or 'wedge 2': Wedge 1 agencies will begin the intervention in Fall 2018 and Wedge 2 agencies will begin the intervention in Spring 2019.
Masking: None (Open Label)
Primary purpose: Prevention