Improving sleep health in paramedics through an app-based intervention: a randomised waitlist control pilot trial

Article

Shriane, Alexandra E., Vincent, Grace E., Ferguson, Sally A., Rebar, Amanda, Kolbe-Alexander, Tracy and Rigney, Gabrielle. 2024. "Improving sleep health in paramedics through an app-based intervention: a randomised waitlist control pilot trial." BMC Public Health. 24 (1). https://doi.org/10.1186/s12889-024-19823-w
Article Title

Improving sleep health in paramedics through an app-based intervention: a randomised waitlist control pilot trial

ERA Journal ID13449
Article CategoryArticle
AuthorsShriane, Alexandra E., Vincent, Grace E., Ferguson, Sally A., Rebar, Amanda, Kolbe-Alexander, Tracy and Rigney, Gabrielle
Journal TitleBMC Public Health
Journal Citation24 (1)
Article Number2395
Number of Pages17
Year2024
PublisherBioMed Central Ltd.
Place of PublicationUnited Kingdom
ISSN1471-2458
Digital Object Identifier (DOI)https://doi.org/10.1186/s12889-024-19823-w
Web Address (URL)https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-19823-w
Abstract

Background
Due to work commitments, shiftworkers often obtain inadequate sleep, consequently experiencing negative health, wellbeing, and safety outcomes. Given shiftworkers may have limited control over their work commitments, lifestyle and environmental factors within their control may present an intervention opportunity. However, such interventions require tailoring to ensure applicability for this sleep-vulnerable population.

Methods
A randomised waitlist control pilot trial investigated the effectiveness of mobile health application Sleepfit, which delivered a tailored sleep health intervention aimed at improving sleep health and sleep hygiene outcomes amongst paramedic shiftworkers. Outcome measures of self-reported sleep health (sleep need, duration, and quality, fatigue, Insomnia Severity Index, Fatigue Severity Scale, and Epworth Sleepiness Scale scores) and sleep hygiene (Sleep Hygiene Index score) were collected at baseline, post-intervention, and 3-month follow-up.

Results
Fifty-eight paramedics (aged 33.4 ± 8.0 years; 50% male) were recruited, and trialed Sleepfit for a 14-day intervention period between August 2021–January 2022. For all participants, there was a significant reduction in Insomnia Severity Index and Sleep Hygiene index scores after intervention engagement. Regression models demonstrated no significant intervention effect on sleep health or sleep hygiene outcomes (intervention versus waitlist control group). A high study drop-out rate (91.4%) prevented assessment of outcomes at 3-month follow-up.

Conclusions
Pilot trial findings demonstrate that Sleepfit may elicit improvements in sleep health and sleep hygiene outcomes amongst paramedic shiftworkers. However, low enrolment and retention means that findings should be interpreted with caution, further highlighting potential engagement challenges, especially among paramedics who are particularly in need of support for improved sleep.

KeywordsmHealth; Sleep hygiene; Shiftwork
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020320219. Paramedicine
Byline AffiliationsCentral Queensland University
School of Health and Medical Sciences
Centre for Health Research
University of Cape Town, South Africa
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Olsen, Heidi M., Brown, Wendy J., Kolbe-Alexander, Tracy and Burton, Nicola W.. 2018. "Physical activity and sedentary behaviour in a flexible office-based workplace: employee perceptions and priorities for change." Health Promotion Journal of Australia. 29 (3), pp. 344-352. https://doi.org/10.1002/hpja.164
Australian fitness professionals' level of interest in engaging with high health-risk population subgroups: findings from a national survey
Bennie, J. A., Thomas, G., Wiesner, G. H., van Uffelen, J. G. Z., Khan, A., Kolbe-Alexander, T., Vergeer, I. and Biddle, S. J. H.. 2018. "Australian fitness professionals' level of interest in engaging with high health-risk population subgroups: findings from a national survey." Public Health. 160, pp. 108-115. https://doi.org/10.1016/j.puhe.2018.03.035
Qualitative evaluation of a physical activity-based chronic disease prevention program in a low-income, rural South African setting
Draper, C. E., Nemutandani, S. M., Grimsrud, A. T., Rudolph, M., Kolbe-Alexander, T. L., de Kock, L. and Lambert, E. V.. 2010. "Qualitative evaluation of a physical activity-based chronic disease prevention program in a low-income, rural South African setting." Rural and Remote Health. 10 (3).
Evaluation of a school-based physical activity intervention in Alexandra Township
Draper, Catherine E., de Kock, Lauren, Grimsrud, Anna T., Rudolph, Michael, Nemutandani, Simon, Kolbe-Alexander, Tracy and Lambert, Estelle V.. 2010. "Evaluation of a school-based physical activity intervention in Alexandra Township." South African Journal of Sports Medicine. 22 (1), pp. 12-19.
Physical activity advocacy and promotion: the South African experience
Kolbe-Alexander, T. L., Bull, Fiona and Lambert, Estelle V.. 2012. "Physical activity advocacy and promotion: the South African experience." South African Journal of Sports Medicine. 24 (4), pp. 112-116.
A systematic review of physical activity-based interventions in shift workers
Flahr, Hannah, Brown, Wendy J. and Kolbe-Alexander, Tracy L.. 2018. "A systematic review of physical activity-based interventions in shift workers." Preventive Medicine Reports. 10, pp. 323-331. https://doi.org/10.1016/j.pmedr.2018.04.004
From evidence-based research to practice-based evidence: disseminating a web-based computer-tailored workplace sitting intervention through a Health Promotion Organisation
De Cocker, Katrien, Cardon, Greet, Bennie, Jason A., Kolbe-Alexander, Tracy, De Meester, Femke and Vandelanotte, Corneel. 2018. "From evidence-based research to practice-based evidence: disseminating a web-based computer-tailored workplace sitting intervention through a Health Promotion Organisation." International Journal of Environmental Research and Public Health. 15 (5). https://doi.org/10.3390/ijerph15051049
Shifting the physical inactivity curve worldwide by closing the gender gap
Mielke, Gregore I., da Silva, Inacio Chrochemore M., Kolbe-Alexander, Tracy L. and Brown, Wendy J.. 2018. "Shifting the physical inactivity curve worldwide by closing the gender gap." Sports Medicine. 48 (2), pp. 481-489. https://doi.org/10.1007/s40279-017-0754-7
The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study
Ramnath, U., Rauch, L., Lambert, E. V. and Kolbe-Alexander, T. L.. 2018. "The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study." PLoS One. 13 (4), pp. 1-16. https://doi.org/10.1371/journal.pone.0194918
Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose–response relationship
Torquati, Luciana, Mielke, Gregore I., Brown, Wendy J. and Kolbe-Alexander, Tracy. 2018. "Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose–response relationship." Scandonavian Journal of Work Environment and Health. 44 (3), pp. 229-238. https://doi.org/10.5271/sjweh.3700
Flexible work: The impact of a new policy on employees’ sedentary behaviour and physical activity
Olsen, Heidi M, Brown, Wendy J., Kolbe-Alexander, Tracy and Burton, Nicola W.. 2017. "Flexible work: The impact of a new policy on employees’ sedentary behaviour and physical activity." Journal of Occupational and Environmental Medicine. 60 (1), pp. 23-28. https://doi.org/10.1097/JOM.0000000000001190
Gender equality in sport for improved public health
Brown, Wendy J., Mielke, Gregore I. and Kolbe-Alexander, Tracy L.. 2016. "Gender equality in sport for improved public health." The Lancet. 388 (10051), pp. 1257-1258. https://doi.org/10.1016/S0140-6736(16)30881-9
Which Women are Highly Active Over a 12-Year Period? A Prospective Analysis of Data from the Australian Longitudinal Study on Women’s Health
Pavey, Toby G., Kolbe-Alexander, Tracy L., Uitdewilligen, Leonie and Brown, Wendy J.. 2017. "Which Women are Highly Active Over a 12-Year Period? A Prospective Analysis of Data from the Australian Longitudinal Study on Women’s Health." Sports Medicine. 47 (12), pp. 2653-2666. https://doi.org/10.1007/s40279-017-0732-0
The economic burden of physical inactivity: a systematic review and critical appraisal
Ding, Ding, Kolbe-Alexander, Tracy, Nguyen, Binh, Katzmarzyk, Peter T., Pratt, Michael and Lawson, Kenny D.. 2017. "The economic burden of physical inactivity: a systematic review and critical appraisal." British Journal of Sports Medicine. 51 (19), pp. 1392-1409. https://doi.org/10.1136/bjsports-2016-097385
Sitting time, physical activity and sleep by work type and pattern – The Australian Longitudinal Study on Women’s Health
Clark, Bronwyn k., Kolbe-Alexander, Tracy L., Duncan, Mitch J. and Brown, Wendy. 2017. "Sitting time, physical activity and sleep by work type and pattern – The Australian Longitudinal Study on Women’s Health." International Journal of Environmental Research and Public Health. 14 (3). https://doi.org/10.3390/ijerph14030290
Participation in fitness-related activities of an incentive-based health promotion program and hospital costs: a retrospective longitudinal study
Patel, Deepak, Lambert, Estelle V., da Silva, Roseanne, Greyling, Mike, Kolbe-Alexander, Tracy, Noach, Adam, Conradie, Jaco, Nossel, Craig, Borrenson, Jill and Gaziano, Thomas. 2011. "Participation in fitness-related activities of an incentive-based health promotion program and hospital costs: a retrospective longitudinal study." American Journal of Health Promotion. 25 (5), pp. 341-348. https://doi.org/10.4278/ajhp.100603-QUAN-172
Construct validity of the neighborhood environment walkability scale for Africa
Oyeyemi, Adewale L., Conway, Terry L., Adedoyin, Rufus A., Akinroye, Kingsley K., Aryeetey, Richmond, Assah, Felix, Cain, Kelli L., Gavand, Kavita A., Kosoma, Sandra S., Kolbe-Alexander, Tracy L., Lambert, Estelle V., Larouche, Richard, Moss, Sarah J., Ocansey, Reginald, Onywera, Vincent O., Prista, Antonio, Tremblay, Mark S. and Sallis, James F.. 2017. "Construct validity of the neighborhood environment walkability scale for Africa." Medicine and Science in Sports and Exercise. 49 (3), pp. 482-491. https://doi.org/10.1249/MSS.0000000000001131
'Be active!' Revisiting the South African food-based dietary guideline for activity
Botha, C. R., Wright, H. H., Moss, Sarah and Kolbe-Alexander, Tracy L.. 2013. "'Be active!' Revisiting the South African food-based dietary guideline for activity." South African Journal of Clinical Nutrition. 26 (3 (Supplement)), pp. S18-S27.
Non-communicable disease prevention and worksite health promotion programs: a brief review
Kolbe-Alexander, T. L. and Lambert, E. V.. 2013. "Non-communicable disease prevention and worksite health promotion programs: a brief review." Occupational Medicine and Health Affairs. 1 (7), pp. 1-8. https://doi.org/10.4172/2329-6879.1000141
Innovative strategies targeting obesity and non-communicable diseases in South Africa: what can we learn from the private healthcare sector?
Lambert, E. V. and Kolbe-Alexander, T. L.. 2013. "Innovative strategies targeting obesity and non-communicable diseases in South Africa: what can we learn from the private healthcare sector?" Obesity Reviews. 14 (2 (Supplement)), pp. 141-149. https://doi.org/10.1111/obr.12094
The relationship between leadership support, workplace health promotion and employee wellbeing in South Africa
Milner, Karen, Greyling, Michael, Goetzel, Ron, da Silva, Roseanne, Kolbe-Alexander, Tracy, Patel, Deepak, Nossel, Craig and Beckowski, Meghan. 2015. "The relationship between leadership support, workplace health promotion and employee wellbeing in South Africa." Health Promotion International. 30 (3), pp. 514-522. https://doi.org/10.1093/heapro/dat064
The perceived role and influencers of physical activity among pregnant women from low socioeconomic status communities in South Africa
Muzigaba, Moise, Kolbe-Alexander, Tracy L. and Wong, Fiona. 2014. "The perceived role and influencers of physical activity among pregnant women from low socioeconomic status communities in South Africa." Journal of Physical Activity and Health. 11 (7), pp. 1276-1283. https://doi.org/10.1123/jpah.2012-0386
The Healthiest Company Index: a campaign to promote worksite wellness in South Africa
Patel, Deepak, Goetzel, Ron Z., Beckowski, Meghan, Milner, Karen, Greyling, Mike, da Silva, Roseanne, Kolbe-Alexander, Tracy, Tabrizi, Maryam J. and Nossel, Craig. 2013. "The Healthiest Company Index: a campaign to promote worksite wellness in South Africa." Journal of Occupational and Environmental Medicine. 55 (2), pp. 172-178. https://doi.org/10.1097/JOM.0b013e3182728d61
The relationship between workplace environment and employee health behaviors in a South African workforce
Kolbe-Alexander, Tracy, Greyling, Michael, da Silva, Roseanne, Milner, Karen, Patel, Deepak, Wyper, Lauren, Beckowski, Meghan, Lambert, Estelle V. and Goetzel, Ron. 2014. "The relationship between workplace environment and employee health behaviors in a South African workforce." Journal of Occupational and Environmental Medicine. 56 (10), pp. 1094-1099. https://doi.org/10.1097/JOM.0000000000000236
Nurses’ lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study
Phiri, Lindokuhle P., Draper, Catherine E., Lambert, Estelle V. and Kolbe-Alexander, Tracy L.. 2014. "Nurses’ lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study." BMC Nursing. 13 (38), pp. 1-11. https://doi.org/10.1186/s12912-014-0038-6
Steps that count: physical activity recommendations, brisk walking, and steps per minute - how do they relate?
Pillay, Julian D., Kolbe-Alexander, Tracy L., Proper, Karin I., van Mechelen, Willem and Lambert, Estelle V.. 2014. "Steps that count: physical activity recommendations, brisk walking, and steps per minute - how do they relate?" Journal of Physical Activity and Health. 11 (3), pp. 502-508. https://doi.org/10.1123/jpah.2012-0210
The relationship between the built environment and habitual levels of physical activity in South African older adults: a pilot study
Kolbe-Alexander, Tracy L., Pacheco, Kyla, Tomaz, Simone A., Karpul, David and Lambert, Estelle V.. 2015. "The relationship between the built environment and habitual levels of physical activity in South African older adults: a pilot study." BMC Public Health. 15 (518), pp. 1-9. https://doi.org/10.1186/s12889-015-1853-8
The association between daily steps and health, and the mediating role of body composition: a pedometer-based, cross-sectional study in an employed South African population
Pillay, Julian D., van der Ploeg, Hidde P., Kolbe-Alexander, Tracy L., Proper, Karin I., van Stralen, Maartjie, Tomaz, Simone A., van Mechelen, Willem and Lambert, Eztelle V.. 2015. "The association between daily steps and health, and the mediating role of body composition: a pedometer-based, cross-sectional study in an employed South African population." BMC Public Health. 15 (174), pp. 1-12. https://doi.org/10.1186/s12889-015-1381-6
A comparative study of Australian and New Zealand male and female nurses’ health: a sex comparison and gender analysis
Tuckett, Anthony, Henwood, Tim, Oliffe, John L., Kolbe-Alexander, Tracy L. and Rin Kim, Jae. 2016. "A comparative study of Australian and New Zealand male and female nurses’ health: a sex comparison and gender analysis." American Journal of Men's Health. 10 (6), pp. 450-458. https://doi.org/10.1177/1557988314567222
Steps that count: pedometer-measured physical activity, self-reported physical activity and current physical guidelines ‒ how do they relate?
Pillay, J. D., Kolbe-Alexander, T. L., Proper, K. I., Tomaz, S. A, van Mechelen, W. and Lambert, E. V.. 2014. "Steps that count: pedometer-measured physical activity, self-reported physical activity and current physical guidelines ‒ how do they relate?" South African Journal of Sports Medicine. 26 (3), pp. 77-81. https://doi.org/10.7196/SAJSM.534
Steps that count: the association between the number and intensity of steps accumulated and fitness and health measures
Pillay, Julian David, Kolbe-Alexander, Tracy L., van Mechelen, Willem and Lambert, Estelle Vicki. 2014. "Steps that count: the association between the number and intensity of steps accumulated and fitness and health measures." Journal of Physical Activity and Health. 11 (1), pp. 10-17. https://doi.org/10.1123/jpah.2011-0288
Clustering of risk factors for non-communicable disease and healthcare expenditure in employees with private health insurance presenting for health risk appraisal: a cross-sectional study
Kolbe-Alexander, Tracy L., Conradie, Jaco and Lambert, Estelle V.. 2013. "Clustering of risk factors for non-communicable disease and healthcare expenditure in employees with private health insurance presenting for health risk appraisal: a cross-sectional study." BMC Public Health. 13 (1213), pp. 1-10. https://doi.org/10.1186/1471-2458-13-1213
Steps that count! A feasibility study of a pedometer-based, healthpromotion intervention in an employed, South African population
Pillay, J. D., Kolbe-Alexander, T. L., Proper, K. I., van Mechelen, W. and Lambert, E. V.. 2014. "Steps that count! A feasibility study of a pedometer-based, healthpromotion intervention in an employed, South African population." South African Journal of Sports Medicine. 26 (1), pp. 15-19. https://doi.org/10.7196/SAJSM.500
Promoting diet and physical activity in nurses: a systematic review
Torquati, Luciana, Pavey, Toby, Kolbe-Alexander, Tracy and Leveritt, Michael. 2017. "Promoting diet and physical activity in nurses: a systematic review." American Journal of Health Promotion. 31 (1), pp. 19-27. https://doi.org/10.4278/ajhp.141107-LIT-562
NEWS for Africa: adaptation and reliability of a built environment questionnaire for physical activity in seven African countries
Oyeyemi, Adewale L., Kasoma, Sandra S., Onywera, Vincent O., Assah, Felix, Adedoyin, Rufus A., Conway, Terry L., Moss, Sarah J., Ocansey, Reginald, Kolbe-Alexander, Tracy L., Akinroye, Kingsley K., Prista, Antonio, Larouche, Richard, Gavand, Kavita A., Cain, Kelli L., Lambert, Estelle V., Aryeetey, Richmond, Bartels, Clare, Tremblay, Mark S. and Sallis, James F.. 2016. "NEWS for Africa: adaptation and reliability of a built environment questionnaire for physical activity in seven African countries." International Journal of Behavioral Nutrition and Physical Activity. 13 (33), pp. 1-12. https://doi.org/10.1186/s12966-016-0357-y
Diet and physical activity behaviour in nurses: a qualitative study
Torquati, Luciana, Kolbe-Alexander, Tracy L, Pavey, Toby, Perrson, Christina and Leveritt, Michael. 2016. "Diet and physical activity behaviour in nurses: a qualitative study." International Journal of Health Promotion and Education. 54 (6), pp. 268-282. https://doi.org/10.1080/14635240.2016.1169943
The economic burden of physical inactivity: a global analysis of major non-communicable diseases
Ding, Ding, Lawson, Kenny D., Kolbe-Alexander, Tracy L., Finkelstein, Eric A., Katzmarzyk, Peter T., van Mechelen, Willem and Pratt, Michael. 2016. "The economic burden of physical inactivity: a global analysis of major non-communicable diseases." The Lancet. 388 (10051), pp. 1311-1324. https://doi.org/10.1016/S0140-6736(16)30383-X
Can the use of Bus Rapid Transit lead to a healthier lifestyle in urban South Africa? The SUN Study
Bartels, Clare, Kolbe-Alexander, Tracy, Behrens, Roger, Hendricks, Sharief and Lambert, Estelle V.. 2016. "Can the use of Bus Rapid Transit lead to a healthier lifestyle in urban South Africa? The SUN Study." Journal of Transport and Health. 3 (2), pp. 200-210. https://doi.org/10.1016/j.jth.2016.04.003
Cardiovascular fitness is associated with bias between self-reported and objectively measured physical activity
Tomaz, S. A., Lambert, E. V., Karpul, D. and Kolbe-Alexander, T. L.. 2016. "Cardiovascular fitness is associated with bias between self-reported and objectively measured physical activity." European Journal of Sport Science. 16 (1), pp. 149-157. https://doi.org/10.1080/17461391.2014.987323
Working on wellness (WOW): a worksite health promotion intervention programme
Kolbe-Alexander, Tracy L., Proper, Karin I., Lambert, Estelle V., van Wier, Marieke F., Pillay, Julian D., Nossel, Craig, Adonis, Leegale and Van Mechelen, Willem. 2012. "Working on wellness (WOW): a worksite health promotion intervention programme." BMC Public Health. 12 (1), pp. 372-383. https://doi.org/10.1186/1471-2458-12-372
Steps that count!: The development of a pedometer-based health promotion intervention in an employed, health insured South African population
Pillay, Julian D., Kolbe-Alexander, Tracy, Proper, Karin I., van Mechelen, Willem and Lambert, Estelle V.. 2012. "Steps that count!: The development of a pedometer-based health promotion intervention in an employed, health insured South African population." BMC Public Health. 12 (1), pp. 880-887. https://doi.org/10.1186/1471-2458-12-880
The impact of sleep restriction and simulated physical firefighting work on acute inflammatory stress responses
Wolkow, Alexander, Ferguson, Sally A., Vincent, Grace E., Larsen, Brianna, Aisbett, Brad and Main, Luana C.. 2015. "The impact of sleep restriction and simulated physical firefighting work on acute inflammatory stress responses." PLoS One. 10 (9), pp. 1-17. https://doi.org/10.1371/journal.pone.0138128