Effects of a sleep hygiene knowledge and mindfulness promoting program for older people with stage 4-5 chronic kidney disease before renal replacement therapy

Abstract

This article is part of a research study on effects of a sleep hygiene knowledge and mindfulness promoting program on sleep-related outcomes among older people with stage 4-5 chronic kidney disease before renal replacement therapy. It presents the program development process, consisting of three stages: preparation, program quality assessment, and outcome evaluation. The research instrument was sleep hygiene knowledge and mindfulness promoting program, which was developed by the researchers and verified by five experts. The data collection instruments were: 1) a sleep hygiene knowledge questionnaire (SHKQ), whose content validity had been verified by five experts and obtained the content validity index (CVI) of 0.80; 2) the Thai version of the Pittsburgh Sleep Quality Index (PSQI); and 3) the Thai version of the Insomnia Severity Index (ISI). Reliability test of these three instruments yielded Cronbach's alpha coefficients of 0.73, 0.82, and 0.89, respectively. A comparison of pre- and post-program outcomes among 32 participants were compared using pair test statistics and Wilcoxon Signed ranks test. The study results revealed that:

1) The program comprised a four-week intervention. On Day 1 of Week 1, activities included rapport building, assessment of needs and experiences related to insomnia, and practice of symptom management strategies based on behavioral and psychological therapies. The materials used were a sleep hygiene promotion handbook for older adults, a mindfulness promotion handbook for older adults, and an MP3 player containing recorded Buddhist music. During Weeks 2–4 (Days 7, 14 and 21), participants received continuous follow-up via telephone. Outcome evaluation was conducted in Week 5 (Day 28).

2) the program quality assessment indicated that content validity index (CVI) of the program and the handbook were 0.95 and 0.92, respectively. The program is feasible/acceptable with a 100% retention rate.

3) outcome evaluation. The participants showed statistically significant improvement in all three areas following participation in the program. Sleep hygiene knowledge scores increased from 13.88±2.12 at baseline to 22.78±1.18 post-intervention (p<0.001). Sleep quality scores improved from 13.19±2.79 to 7.00±2.27 (p<0.001), and the severity of insomnia decreased from 15.88±5.46 to 7.59±2.71 (p<0.001).

The developed program demonstrated high quality, feasibility, acceptability, and effectiveness. It is, therefore, recommended for implementation to promote sleep among older people with stage 4–5 chronic kidney disease prior to renal replacement therapy who experience sleep disturbances. Further studies should be conducted to evaluate its applicability among other older populations with similar health conditions.