Sleep Hygiene Education in Associate Degree Health Sciences Students: A Randomized Controlled Trial

This study was conducted as a pre-test-post-test, parallel-group randomized controlled trial to evaluate the effect of a Transtheoretical Model-guided sleep hygiene education program on sleep hygiene behaviors, sleep quality, and sleep hygiene knowledge among associate degree health sciences students participating in clinical practice.

The study included 100 students enrolled in the Operating Room Services, Dialysis, and Emergency Medical Services programs at a School of Health Services affiliated with a state university in northwestern Türkiye. Eligible participants provided written informed consent and completed baseline assessments before randomization. Participants were randomly allocated in a 1:1 ratio to an intervention group (n=50) or a control group (n=50) using a pre-generated simple randomization sequence.

The intervention group received a four-week, face-to-face sleep hygiene education program guided by the Transtheoretical Model. Four sessions were conducted on December 3, 10, 17, and 24, 2025. Each session lasted approximately 40 minutes. The sessions progressed from awareness and reflection on current sleep-related behaviors to preparation, goal setting, implementation of behavior-change strategies, and maintenance-oriented planning. The educational content included sleep hygiene principles, regular sleep schedules, caffeine and screen use, sleep environment, physical activity, stress management, relaxation strategies, and preparation of an individual sleep plan. Brief one-way WhatsApp reminders related to sleep hygiene were also sent to intervention-group participants three times per week during daytime hours. The control group received no sleep-related educational intervention during the study period.

Data were collected using the Student Life and Sleep Factors Questionnaire, Sleep Hygiene Index, Pittsburgh Sleep Quality Index, and a researcher-developed 10-item Sleep Hygiene Knowledge Test. The Sleep Hygiene Index was used to assess sleep hygiene behaviors, with higher scores indicating poorer sleep hygiene. The Pittsburgh Sleep Quality Index was used to assess sleep quality, with higher scores indicating poorer sleep quality. The Sleep Hygiene Knowledge Test was used as an intervention-specific measure of sleep hygiene knowledge.

The study procedure consisted of eligibility screening, informed consent, baseline assessment, randomization, intervention, and post-intervention assessment. After completion of the fourth educational session on November 28, 2025, post-test assessments were completed in both groups using the same outcome measures. Sleep hygiene behaviors and sleep quality were considered the main study outcomes, while sleep hygiene knowledge was evaluated as an additional outcome.

• sleep hygiene education (Behavioral): The intervention consisted of a four-session, face-to-face sleep hygiene education program guided by the Transtheoretical Model. Sessions were delivered once weekly for approximately 40 minutes by a nurse with at least five years of professional experience in sleep health. The educational content included sleep hygiene principles, regular sleep schedules, caffeine and screen use, sleep environment, physical activity, stress management, relaxation strategies, individual goal setting, preparation of a personal sleep plan, and strategies for maintaining healthy sleep behaviors. Brief one-way WhatsApp reminders were sent three times per week during daytime hours to support the educational content.

Primary outcomes

• Change in Sleep Hygiene Index (SHI) Total Score [Baseline to post-intervention assessment after completion of the fourth weekly session (December 24, 2025)]: Sleep hygiene behaviors were assessed using the Sleep Hygiene Index (SHI), a 13-item instrument scored on a 5-point Likert scale. Total scores range from 13 to 65, with higher scores indicating poorer sleep hygiene behaviors. The outcome was evaluated by comparing the change in SHI total score from baseline to the post-intervention assessment between the intervention and control groups.
• Change in Pittsburgh Sleep Quality Index (PSQI) Total Score [Baseline to post-intervention assessment after completion of the fourth weekly session (December 24, 2025)]: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The total score ranges from 0 to 21, with higher scores indicating poorer sleep quality. The outcome was evaluated by comparing the change in PSQI total score from baseline to the post-intervention assessment between the intervention and control groups.

Secondary outcomes

• Change in Sleep Hygiene Knowledge Test Score [Baseline to post-intervention assessment after completion of the fourth weekly session (December 24, 2025)]: Sleep hygiene knowledge was assessed using a researcher-developed 10-item multiple-choice Sleep Hygiene Knowledge Test. Correct responses were scored as 1 and incorrect responses as 0, yielding a total score ranging from 0 to 10. Higher scores indicate greater sleep hygiene knowledge. The outcome was evaluated by comparing the change in total score from baseline to the post-intervention assessment between the intervention and control groups.

Sex: All, ages: 18 Years to 25 Years

Inclusion Criteria:

\- Being an associate degree student at the School of Health Services - Participating in hospital clinical practice - Being between 18 and 25 years of age - Scoring 30 or higher on the Sleep Hygiene Index (SHI) - Voluntarily agreeing to participate in the study - Providing written informed consent - Not having received any sleep hygiene education within the previous 3 months - Being able to participate regularly throughout the study process

Exclusion Criteria:

\- Having a diagnosed sleep disorder - Having a diagnosed psychiatric condition that could affect mental health and/or regularly taking psychiatric medication - Having a chronic illness and regularly taking medication - Working night shifts or having an irregular sleep schedule - Being unable to participate regularly throughout the study process - Failing to comply with the study intervention