An Interactive Smartphone App, Nenne Navi, for Improving Children’s Sleep: Pilot Usability Study
Authors: Yoshizaki Arika , Mohri Ikuko , Yamamoto Tomoka , Shirota Ai , Okada Shiho , Murata Emi , Hoshino Kyoko , Kato-Nishimura Kumi , Matsuzawa Shigeyuki , Kato Takafumi , Taniike Masako 
Published: October 2020

Background
Healthy sleep is important not only for physical health but also for brain development in children. Several reports have revealed that Japanese adults and children have later bedtimes and shorter sleep durations compared with those in other countries, possibly because of Japanese culture and lifestyles. Therefore, an intervention tool that is suitable to the Japanese sociocultural environment is urgently needed to improve children’s sleep problems in their early years.

Objective
To provide appropriate sleep health literacy to caregivers and change their parenting behavior, we developed a smartphone app that allows reciprocal interaction between caregivers and pediatric sleep experts. This paper describes a preliminary study to examine the app’s basic design and functions and to establish its acceptability and usability in a small sample.

Methods
A total of 10 caregivers and 10 infants (aged 18-28 months; 4/10, 40% boys) living in Japan participated in the study. At the start of the trial, the e-learning content regarding sleep health literacy was delivered via a smartphone. Thereafter, caregivers manually inputted recorded data about their own and their infant’s sleep habits for 8 consecutive days per month for 2 months. After pediatric sleep experts retrieved this information from the Osaka University server, they specified the problems and provided multiple sleep habit improvement suggestions to caregivers. Caregivers then selected one of the feasible pieces of advice to practice and reported their child’s sleep-related behaviors via the app. Actigraphy was used to monitor children’s sleep behaviors objectively. The concordance between the information provided by caregivers and the actigraphy data was assessed. The acceptability and usability of the app were evaluated using self-report questionnaires completed by caregivers; qualitative feedback was obtained via semistructured interviews after the intervention.

Results
There was no significant difference between the information provided by the caregivers and the actigraphy data for bedtimes and wake-up times (P=.13 to P=.97). However, there was a difference between the actigraphy data and the caregivers’ reports of nighttime sleep duration and nighttime awakenings (P<.001 each), similar to prior findings. User feedback showed that 6 and 5 of the 10 caregivers rated the app easy to understand and easy to continue to use, respectively. Additionally, 6 of the 10 caregivers rated the app’s operativity as satisfactory. Although this was a short-term trial, children’s sleep habits, caregivers’ sleep health consciousness, and parenting behaviors improved to some extent.

Conclusions
The present findings suggest that the app can easily be used and is acceptable by Japanese caregivers. Given the user feedback, the app has the potential to improve children’s sleep habits by sending individualized advice that fits families’ backgrounds and home lives. Further studies are needed to confirm the efficacy of the app and facilitate social implementation.