Comparison of the effectiveness of two educational interventions on sleep quality in older adults: a randomized clinical trial

Carvalho, Khelyane Mesquita de; Figueiredo, Maria do Livramento Fortes; Galindo Neto, Nelson Miguel; Sá, Guilherme Guarino de Moura; Silva, Cynthia Roberta Dias Torres; Mendes, Polyana Norberta

doi:10.1590/1980-220X-REEUSP-2022-0326en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2022-0326en copy

Comparison of the effectiveness of two educational interventions on sleep quality in older adults: a randomized clinical trial^* *Extracted from a doctoral thesis entitled “Efeitos de tecnologia educacional na qualidade de sono de older adults: estudo randomizado controlado”, Universidade Federal do Piauí, 2019.

Comparación de la efectividad de dos intervenciones educativas sobre la calidad del sueño en ancianos: un ensayo clínico aleatorizado

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to compare the effectiveness of an educational intervention mediated by a booklet with verbal nursing guidelines in improving sleep quality in older adults.

Method:

this is a randomized, single-blind clinical trial, carried out with 126 older adults, of which 62 were allocated in group 1, who received health education using an educational booklet, and 64 in group 2, who were exposed to health education with verbal nursing guidelines. Sleep quality was verified by the Pittsburgh Index, Epworth Sleepiness Scale and variable minutes that it takes to sleep. In order to compare the pre and post-tests, within the group, the Wilcoxon and chi-square tests were used. Status change was assessed using McNemar’s chi-square test. To compare groups, Mann-Whitney and chi-square were used. The significance level was 5%.

Results:

older adults in both groups showed improvement in sleep quality (p > 0.05) after the interventions. There was no statistically significant difference between the interventions.

Conclusion:

the educational intervention mediated by a booklet and verbal nursing guidelines were equally effective in improving older adults’ sleep quality. RBR-993xf7.

DESCRIPTORS
Age; Slee; Nursing Car; Educational Technology

Variable	Pre-intervention		Post-intervention		p-value*
Variable	N	%	N	%	p-value*
Sleep efficiency/sleep hours per night (%)
> 85	31	50.00	52	83.87	< 0.001
75 to 84	12	19.35	8	12.90	0.503
65 to 74	6	9.67	2	3.22	0.289
< 65	13	20.96	0	0	^†
Waking up at night to go to the bathroom (per week)
None	6	9.67	5	8.06	1.000
Less than 1	6	9.67	11	17.74	0.227
1 or 2	6	9.67	14	22.58	0.077
3 or more	44	70.96	32	51.61	0.004
Self-rated sleep
Very good	6	9.67	3	4.83	0.508
Good	24	38.70	50	80.64	< 0.001
Poor	29	46.77	8	12.90	< 0.001
Very poor	3	4.83	1	1.61	0.500
Wake up in the middle of the night or early morning (per week)
None	0	0	5	8.06	0.063
Less than 1 time/week	3	4.83	8	12.90	0.180
1 or 2 times/week	7	11.29	11	17.74	0.388
3 or more times/week	52	83.87	38	61.29	0.007
Concern as cause of sleep loss (per week)
None	15	24.19	30	48.38	0.007
Less than 1 time/week	20	32.25	7	11.29	0.011
1 or 2 times/week	7	11.29	13	20.96	0.263
3 or more times/week	20	32.25	12	19.35	1.907

Variable	Pre-intervention		Post-intervention		p-value*
Variable	N	%	n	%	p-value*
Sleep efficiency/sleep hours per night (%)
> 85	23	35.93	53	82.81	< 0.001
75 to 84	18	28.12	8	12.50	0.004
65 to 74	7	10.93	2	3.12	0.700
< 65	16	25.00	1	1.56	< 0.001
Waking up at night to go to the bathroom (per week)
None	9	14.06	5	7.81	0.250
Less than 1	6	9.37	11	17.18	0.581
1 or 2	8	12.50	14	21.87	0.454
3 or more	41	64.06	34	53.12	0.481
Self-rated sleep
Very good	1	1.56	3	4.68	0.625
Good	27	42.18	50	78.12	< 0.001
Poor	29	45.31	9	14.06	0.002
Very poor	7	10.93	2	3.12	0.070
Trouble sleeping in up to 30 minutes (per week)
None	6	9.37	15	23.43	0.049
Less than 1 time/week	7	10.93	6	9.37	1.451
1 or 2 times/week	7	10.93	12	18.75	0.167
3 or more times/week	44	68.75	31	48.43	0.006
Wake up in the middle of the night or early morning (per week)
None	2	3.12	5	7.81	0.063
Less than 1 time/week	2	3.12	8	12.50	0.687
1 or 2 times/week	6	9.37	11	17.18	0.077
3 or more times/week	54	84.37	40	62.50	0.001
Concern as cause of sleep loss (per week)
None	7	10.93	30	46.87	0.012
Less than 1 time/week	19	29.68	7	10.93	1.558
1 or 2 times/week	13	20.31	13	20.31	1.000
3 or more times/week	25	39.06	14	21.87	0.064

Variable Median	Group 1		Group 2		p-value*
Variable Median	Median	(Min/Max)	Median	(Min/Max)	p-value*
Pre-intervention
PSQI	19.5	(7.38)	19.5	(6.38)	0.467
Epwort	6	(0.21)	7	(0.21)	0.654
Minutes to fall asleep	60	(0.180)	85	(0.240)	0.007
Post-intervention
PSQI	18.0	(8.35)	20	(8.35)	0.145
Epwort	8	(0.20)	8	(0.17)	0.730
Minutes to fall asleep	20	(0.180)	25	(0.240)	0.440
Difference
PSQI_DIF	2	(–25.25)	2	(–14.15)	0.506
Epwort	–1	(–12.12)	–0.5	(–11.12)	0.428
Minutes to fall asleep	10	(–55.180)	40	(–180.24)	0.028

Variable	Pre-intervention			Post-intervention
Variable	Group 1 n (%)	Group 2 n (%)	p-value	Group 1 n (%)	Group 2 n (%)	p-value
Hours of sleep per night
> 85%	31 (57.4%)	23 (42.6%)	0.111*	47.3%	58 (52.7%)	0.255*
75% a 84%	12 (40.0%)	18 (60.0%)	0.298*	8 (66.7%)	4 (33.3%)	0.203*
65% to 74%	6 (46.2%)	7 (53.8%)	0.816*	2 (66.7%)	1 (33.3%)	0.616^†
< 65%	13 (44.8%)	16 (55.2%)	0.591*	0 (0.0%)	1 (100.0%)	1.000^†
Waking up at night to go to the bathroom (per week)
None of the time	6 (40.0%)	9 (60.0%)	0.447*	5 (45.5%)	6 (54.5%)	0.794*
Less than 1 time/week	6 (50.0%)	6 (50.0%)	0.954*	11 (55.0%)	9 (45.0%)	0.572*
1 or 2 times/week	6 (42.9%)	8 (57.1%)	0.614*	14 (53.8%)	12 (46.2%)	0.595*
3 or more times/week	44 (51.8%)	41 (48.2%)	0.408*	32 (46.4%)	37 (53.6%)	0.485*
Self-rated sleep
Very good	6 (85.7%)	1 (14.3%)	0.060*	3 (50.0%)	3 (50.0%)	1.000^†
Good	24 (47.1%)	27 (52.9%)	0.691*	50 (51.0%)	48 (49.0%)	0.446*
Poor	29 (50.9%)	28 (49.1%)	0.733*	8 (42.1%)	11 (57.9%)	0.502*
Very poor	3 (27.3%)	8 (72.7%)	0.128*	1 (33.3%)	2 (66.7%)	1.000^†
Trouble sleeping in up to 30 minutes (per week)
None	10 (62.5%)	6 (37.5%)	0.255*	15 (50.0%)	15 (50.0%)	0.921*
Less than 1 time/week	4 (36.4%)	7 (63.6%)	0.372*	6 (50.0%)	6 (50.0%)	0.954*
1 or 2 times/week	10 (58.8%)	7 (41.2%)	0.394*	12 (46.2%)	14 (53.8%)	0.727*
3 or more times/week	38 (46.3%)	44 (53.7%)	0.380*	29 (50.0%)	29 (50.0%)	0.869*
Wake up in the middle of the night or early morning (per week)
None	0 (0.0%)	2 (100.0%)	0.496^†	5 (41.7%)	7 (58.3%)	0.583*
Less than 1 time/week	3 (60.0%)	2 (40.0%)	0.677^†	8 (66.7%)	4 (33.3%)	0.203*
1 or 2 times/week	7 (53.8%)	6 (46.2%)	0.724*	11 (44.0%)	14 (56.0%)	0.561*
3 or more times/week	52 (49.1%)	54 (50.9%)	0.938*	38 (49.4%)	39 (50.6%)	0.968*
Concern as cause of sleep loss (per week)
None	15 (71.4%)	6 (28.6%)	0.056*	29 (61.7%)	18 (38.3%)	0.501*
Less than 1 time/week	20 (51.3%)	19 (48.7%)	0.755*	7 (30.4%)	16 (69.6%)	0.066*
1 or 2 times/week	7 (35.0%)	13 (65.0%)	0.166	13 (48.1%)	14 (51.9%)	0.901*
3 or more times/week	20 (43.5%)	26 (56.5%)	0.329*	13 (44.8%)	16 (55.2%)	0.591*

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Khelyane Mesquita de Carvalho Rua Desembargador Helvídio Aguiar, 1532, Morada do Sol 64056-485 – Teresina, PI, Brazil khelyanemc@gmail.com