Feasibility and acceptability of a sleep health intervention among adolescents in Ugandan schools: A prospective pilot intervention study.

Abstract Study Objectives There is little research on sleep health interventions in Africa. We assessed the feasibility and acceptability of a tiered sleep health intervention among Ugandan adolescents. The intervention, delivered in two secondary schools, comprised universal components (sleep education sessions, structural changes to light, temperature and school-timings) plus targeted psychologist-delivered group cognitive behaviour therapy for insomnia (CBT-I) for students with moderate/severe insomnia (Insomnia Severity Index >15). Methods Feasibility and acceptability were assessed through semi-structured interviews immediately after the intervention (T1) and 3 months later (T2) among students with baseline (T0) insomnia, teachers and dormitory matrons, along with structured implementation trackers. We conducted a quantitative survey at baseline to assess prevalence of dimensions of sleep and mental health, and for those with insomnia only, repeated this at T1 and T2. Results The intervention was feasible and acceptable. High fidelity, dose and reach were achieved through integration of sleep education to the school schedule, structural changes to light, temperature and wake-up time for boarding students, effective small group delivery of CBT-I sessions and good retention despite fatigue due to extended sessions. Acceptability was reflected in high student engagement and positive feedback on the relevance of both universal and targeted components. Among 36 students with baseline insomnia, prevalence of moderate/severe insomnia decreased to 19.4% (7/36) post-intervention and further to 3.6% (1/28) at three months, indicating strong potential for impact. Conclusions Multi-level, school-based sleep interventions can be successful in low-income settings. Large-scale cluster-randomized controlled trials are needed to estimate impact and cost-effectiveness.