Charge your Brainzzz 2.0: evaluation of a co-created healthy sleep intervention for adolescents using a complex systems approach

Dutch teens today are sleeping too little, often experience poor quality sleep and the great majority reports being structurally tired during the day. Consequently, we face a serious public health threat as poor sleep causes teens immediate harm (e.g. impaired cognitive development, increased obesity and depression risks) in a crucial developmental life phase, but also increases their risks of long-term health consequences such as diabetes and cardiovascular disease. Therefore, Brain Foundation Netherlands developed educational program Charge Your Brainzzz (CYB), the first and only preventive intervention promote healthy sleep in 13-15 year old Dutch teens. CYB aimed to build teens’ knowledge, attitudes, subjective norms and self-efficacy in relation to sleep in order to bolster teens’ intentions and subsequent healthy sleep behavior. CYB was appreciated by its implementers (teachers; school staff) and well-received by the teens. Even more, CYB effectively stimulated knowledge, attitude and self-efficacy but these changes did not translate to changes in intentions or actual sleep behaviors. Altogether, CYB 1.0 serves as our study’s starting point in which we aim (1) extend and improve upon CYB by developing a more comprehensive CYB 2.0 , (2) perform a large evaluation trial to study its effects on sleep health in 12-15 year old teens and implementation processes, and (3) create a thorough communication, implementation and structural policy embedment plan to have CYB 2.0 implemented at large scale in the Netherlands. First, the needed CYB-improvements consist of: • APPLYING A COMPLEX ADAPTIVE SYSTEMS (CAS) APPROACH CYB focused on the personal behavioral determinants knowledge, attitudes and self-efficacy to stimulate sleep behavior change; we will extend this by applying a CAS approach, which inherently respects and deals with the multilevel nature of complex behaviors such as sleep, and in doing so, is capable of effective, sustainable, and scalable change. Via CAS, CYB expands to address the full range of social-environmental variables (e.g. peer influences, parental rules) and sleep-related behaviors (e.g. late-night media use) needed to influence teens’ sleep behavior • CO-CREATING CYB 2.0 VIA PARTICIPATORY ACTION RESEARCH (PAR) We use PAR to involve users (i.e. 13-15 year old teens, parents) and implementers in CO-CREATING CYB 2.0 so that it fits their wishes and needs, as this is vital for designing an appropriate, effective health behavior change intervention in teens,implementation success and consequently effectiveness. • TAILOR IT TO BE APPROPRIATE FOR DIFFERENT CULTURES AND EDUCATIONAL LEVELS CYB 2.0 will be made to suit students with different educational/literacy levels and a wider multi-cultural audience than CYB 1.0, especially since non-native Dutch teens and/or those from lower educational levels report the most problematic sleep habits, while CYB currently is not fine-tuned to them. What CYB 2.0 will exactly look like, i.e. what behavioral change methods it will entail, cannot be determined up front, since our PAR approach and need to map the complex system of behavioral determinants that influence sleep (both part 1 of our project) precede intervention improvement. Second, to study CYB 2.0’s effects, appreciation and implementation process, we will perform a large controlled trial study in 5 to 8 intervention vs 5 to 8 control school sample. For this, we will implement CYB 2.0 in four large Municipal Health Services (MHS)-regions in the Netherlands (i.e. Amsterdam, Rotterdam, Kennemerland and Hollands-Midden) and determine quantitative effects on sleep behavior and related factors via use of MHS routine data collection system JEJG. Each year, JEJG collects longitudinal data in over 70.000 teens from year 2 and 4 of secondary school, which our MHS partners make freely available to use in our CYB 2.0 study. Thus, our project requires no specific quantitative data collection of our own. To assess CYB 2.0’s implementation processes, we will conduct interviews and focus groups with users, implementers and other key stakeholders. This results in a manual describing the required infrastructure, time, competences, resources and materials for implementation for all parts of the intervention. Third, we create a communication and dissemination plan to structurally implement, disseminate and embed CYB 2.0 in local, regional and national policies and infrastructures, and facilitate knowledge valorization. As poor teen sleep impacts much more policy domains than ‘just’ public health alone, design CYB 2.0 to be implemented and embedded across sectors, via the HEALTH-IN-ALL-POLICIES FRAMEWORK. Our consortium has been composed specifically so that, aside from possessing the necessary outstanding academic credentials, it has vast experience in translating research to practice so that the chain from fundamental research to the scaled application and the policy embedment of CYB 2.0 can be realized.