Date Presented 03/28/20
This mixed-methods study informs OT on the quality, beliefs, attitudes, and functional outcomes of sleep among a sample population of active-duty soldiers. Significant relationships were found between poor quality, increased dysfunctional beliefs about sleep, and perceived decreased daily function. An overall essence emerged that contrary to acquiring knowledge of sleep hygiene principles, limited self-efficacy obstructs the ability to implement those principles.
Primary Author and Speaker: Jamie Bell
Additional Authors and Speakers: James Contessa
Contributing Authors: Chelsea Truax, Brandon Stanley, Brian Gregg, Enrique Smith-Forbes, Yvette Woods
BACKGROUND: Sleep disturbances are an ongoing concern amongst the active duty (AD) Army community. The Performance Triad, implemented in 2013, includes a focus on sleep education and hygiene; however, sleep disturbances remain prevalent. To date, there are no studies evaluating the attitudes, beliefs, and sleep quality of AD Soldiers and sleep’s perceived impact on occupational performance. The purpose of this study was to identify these variables to understand how sleep is experienced on AD and its perceived impact on performance. The aims for this study included (1) determining the current attitudes, beliefs and sleep quality of AD Soldiers, (2) exploring the relationship between attitudes and beliefs about sleep, sleep quality and perceived impact on occupational performance and (3) examining the experiences of sleep within the AD Army community.
METHODS: This triangulation convergence, mixed methods design study recruited AD Army Soldiers with at minimum two years time in service between the ages of 20-62 years. Recruitment took place at a military training installation. The outcome measures used for this study included the Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Beliefs and Attitudes about Sleep Questionnaire (DBAS), and the Functional Outcomes of Sleep Questionnaire (FOSQ) and demographic information. Chi-Square, Mann-Whitney U and Kruskal-Wallis tests were calculated to examine differences in demographic among groups and to explore the relationship between attitudes and beliefs about sleep, sleep quality and perceived impact on occupational performance. All Soldiers were invited to participate in a semi-structured interview investigating the perceptions of sleep participation and factors which enable and limit sleep obtainment, to which 11 Soldiers agreed. This study utilized Colaizzi’s phenomenological method of qualitative data analysis which includes the determination of appropriate themes.
RESULTS: The quantitative results of this study, in a sample of 102 AD Soldiers, discovered significant relationships between poor sleep quality, increased dysfunctional beliefs and attitudes about sleep and decreased perceived daily function. Additionally, poor sleep quality was significant for Soldiers endorsing higher caffeine use (p=0.009), and caffeine amount (p=0.011). Dysfunctional beliefs were significant amongst training location and for reported alcohol use (p=0.036), pass/fail of most recent APFT (p=0.045), alcohol use (p=0.017), and alcohol amount (p=0.028). Finally, eleven qualitative semi-structured interviews revealed three major themes in examining the experiences of sleep within the AD Army community. The major themes included (1) the exclusivity of sleep on AD, (2) Soldier performance is directly influenced by sleep and (3) recognition of the Army’s sleep culture. An overall essence emerged amongst the Soldiers that contrary to acquiring knowledge of sleep hygiene principles, limited self-efficacy obstructs the ability to implement those principles for themselves, their subordinates and the Army culture.
CONCLUSIONS: The majority of study participants had poor sleep quality. Poor sleep quality demonstrated significant relationships with both dysfunctional beliefs about sleep and perceived daily performance. Additionally, self-efficacy was found to be a primary barrier to implementing sleep hygiene principles for change in sleep for this sample population. This study is paramount for guiding occupational therapy evidence-based treatment approaches aimed at restful sleep obtainment and optimal occupational performance in Army service members.
References
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