Charge your Brainzzz 2.0: development and evaluation of a co-created healthy sleep approach for adolescents using a complex systems approach

Dutch teens today are sleeping too little, often experience poor quality sleep and the great majority reports being structurally tired during the day. Consequently, we face a serious public health threat as poor sleep causes teens immediate harm (e.g. impaired cognitive development, increased obesity and depression risks) in a crucial developmental life phase, but also increases their risks of long-term health consequences such as diabetes and cardiovascular disease. Therefore, Brain Foundation Netherlands developed educational program Charge Your Brainzzz (CYB), the first and only preventive intervention promote healthy sleep in 13-15 year old Dutch teens. CYB aimed to build teens’ knowledge, attitudes, subjective norms and self-efficacy in relation to sleep in order to bolster teens’ intentions and subsequent healthy sleep behavior. CYB was
appreciated by its implementers (teachers; school staff) and well-received by the teens. Even more, CYB effectively stimulated knowledge, attitude and self-efficacy but these changes did not translate to changes in intentions or actual sleep behaviors.
Altogether, the original CYB serves as our study’s starting point in which we aim (1) extend and improve upon CYB by developing a more comprehensive CYB 2.0 , (2) perform a large evaluation trial to study its effects on sleep health in 12-15 year old teens and implementation processes, and (3) create a thorough communication, implementation and structural policy embedment
plan to have CYB 2.0 implemented at large scale in the Netherlands.
First, the needed CYB-improvements consist of:
• APPLYING A COMPLEX ADAPTIVE SYSTEMS APPROACH
CYB focused on the personal behavioral determinants knowledge, attitudes and self-efficacy to stimulate changes in sleep related behaviors; we will extend this by applying a complex adaptive systems approach, which inherently respects and deals with the multilevel nature of complex problems such as sleep health, and in doing so, is capable of effective, sustainable, and scalable change. Via a complex approach, CYB expands to address the full range of social-environmental variables (e.g. peer influences, parental rules) and sleep-related behaviors (e.g. late-night media use) needed to influence teens’ sleep health
• CO-CREATING CYB 2.0 VIA PARTICIPATORY RESEARCH
We use participatory research to involve users (i.e. 13-15 year old teens, parents) and implementers in co-creating CYB 2.0 so that it fits their wishes and needs, as this is vital for designing an appropriate, effective health behavior change intervention in teens, implementation success and consequently effectiveness.
CYB 2.0 will be made to suit students with secondary prevocational education (i.e. VNBO) since these students report the most problematic sleep habits,
while CYB 1.0 currently is not fine-tuned to them. What CYB 2.0 will exactly look like, i.e. what behavioral change methods it will entail, cannot be determined up front, since our participatory approach and need to map the complex system of behavioral determinants that influence sleep (both part 1 of our project)
precede intervention improvement.
Second, to assess CYB 2.0’s implementation processes, we will conduct interviews and focus groups with users, implementers and other key stakeholders. This results in a manual describing the required infrastructure, time, competences, resources and materials for implementation for all parts of the approach.
Third, we create a communication and dissemination plan to structurally implement, disseminate and embed CYB 2.0 in local, regional and national policies and infrastructures, and facilitate knowledge valorization. As poor teen sleep impacts much more policy domains than ‘just’ public health alone, design CYB 2.0 to be implemented and embedded across sectors, via the
Health-in-all-policies framework. Our consortium has been composed specifically so that, aside from possessing the necessary outstanding academic credentials, it has vast experience in translating research to practice so that the chain from fundamental research to the scaled application and the policy embedment of CYB 2.0 can be realized.

Goed slapen is enorm belangrijk voor een gezond lichaam en gezonde hersenen. Terwijl je slaapt worden je hersenen als het ware weer schoongespoeld. Tijdens je slaap verwerk je alle indrukken van de dag, geef je gevoelens een plaats en zorg je ervoor dat je alle belangrijke dingen onthoudt.

Voor tieners is slaap nog eens extra belangrijk. De hersenen zijn op die leeftijd namelijk nog volop in ontwikkeling. Helaas slapen Nederlandse tieners over het algemeen vrij slecht. Ze slapen te kort en de slaap die ze wel krijgen is van slechte kwaliteit.

Slechte slaap leidt bij tieners tot verschillende problemen, zoals slechte prestaties op school, slechtere lichamelijke en mentale gezondheid en
ongezondere leefstijl zoals meer kans op misbruik van alcohol en drugs. Om jongeren te leren hoe belangrijk goede slaap is, heeft de Hersenstichting het lesprogramma Charge Your Brainzzz ontwikkeld. Dit programma wordt goed ontvangen door leraren en tieners. Het heeft er alleen nog niet voor gezorgd dat de tieners die het programma volgden ook beter zijn gaan slapen.
Het is nodig dat tieners begrijpen waarom goede slaap belangrijk is. Maar het is ook nodig dat de omgeving waarin zij leven dat snapt. Het leven van een tiener kan namelijk erg druk zijn. School, ouders, sportclubs, vrienden en andere zaken vragen veel tijd en aandacht.

Wij willen daarom werken aan een verbeterde versie van het originele Charge Your Brainzzz programma: Charge Your Brainzzz 2.0. In dit nieuwe programma wordt de omgeving van tieners meer betrokken. Ook is er aandacht voor de invloed van sociale media en stress op de slaap van tieners.

Het nieuwe programma wordt ontwikkeld samen met vmbo-leerlingen en hun omgeving. Denk hierbij aan hun ouders, leraren, schooladviseurs en andere professionals die invloed hebben op het leven van de leerlingen. Er is gekozen voor vmbo-leerlingen, omdat uit onderzoek blijkt dat zij vaak slechter slapen dan leerlingen van andere schoolrichtingen.