Let them sleep, for when they are awake, they will move mountains: A multisectoral approach to promoting children’s sleep health

Sleep health is an important part of children’s physical- and psychosocial health, and crucial for their cognitive development. Sleeping well also contributes to a healthy weight, learning new things, performing well in different aspects of their lives, and feeling mentally healthy. Alongside the various health-related and social benefits of good sleep health, promoting sleep health among those in a vulnerable position (e.g. living in a deprived neighbourhood or coming from a family with a lower socioeconomic position (SEP)) leads to reducing social disparities and economic costs throughout society. Therefore, the total impact of promoting sleep health reaches far wider than population health.

Over the last decades, children’s sleep health has deteriorated. Evidence-based health promotion programmes are urgently needed to reverse this trend. Therefore, the aim of this thesis is to describe the systematic development of a programme to promote sleep health for children aged 4-12 years old. For this, we combined Intervention Mapping (IM) with the Health in All Policies perspective (HiAP) to guide the development of a children’s sleep health promotion programme. This thesis primarily focuses on the context of the City of Amsterdam, the Netherlands, but also sheds light on how the results may be transferred to other contexts.

To successfully inform intervention programme development, we first conducted a thorough needs assessment to get a clear overview of the determinants of children’s sleep health. This needs assessment, described in chapters 2 to 5, consisted of several studies, i.e. a systematic literature review, two concept mapping studies, and a cross-sectional study using a questionnaire and a sleep diary. All studies provided information about potential determinants of children’s sleep health. Applying the evidence from the needs assessment, we designed a blueprint for the development of a sleep health promotion programme using IM and HiAP.

The studies described in this thesis illustrate that children’s sleep health is a complex phenomenon, since it is influenced by many (potentially interacting) personal, behavioural- and environmental determinants, which exist on several social-ecological levels and are often influenced by multiple different actors and sectors. This complexity further increases when children’s sleep health is seen as part of a wider system in which sleep health is intertwined with other health behaviours such as diet, physical activity, and sedentary behaviour. To effectively impact one or more of these health-related behaviours, this complexity must be considered by all fields.

In addressing sleep health inequalities, comprehensive multi-level systems approaches can be a valuable step forward. To promote sleep health equity, long-term collaboration between relevant actors across multiple sectors is needed, which is precisely what the ‘Health in All Policies’ (HiAP) perspective aims to achieve. In addition, strong collaboration is needed between research, policy and practice to establish an integrated approach that includes multiple factors, social-ecological levels, and sectors.

Children’s sleep health is a multifaceted phenomenon that includes multiple dimensions. However, there is still no consensus about the definition of all these dimensions. We therefore recommend that future research includes the multidimensionality of sleep health, and creates uniform, clear definitions for all dimensions of children’s sleep health. Furthermore, there is a need for valid and reliable child sleep health assessment instruments incorporating this multidimensionality.

To conclude, the studies described in this thesis imply that children’s inadequate sleep health can be viewed as a complex problem, indicating that the promotion of children’s sleep health requires multifactorial, multilevel, and multisectoral action. We recommend the integration of children’s sleep health promotion in a wider municipal HiAP approach, in which all relevant policy, practice and research actors across sectors collaborate to improve the system and underlying mechanisms contributing to children’s sleep health equity.