An opportunity to sleep well in hospital: development of a multi-level intervention to improve inpatient sleep (ASLEEP) using behaviour change theories

Background: Sleep is substantial issue for hospital inpatients and can negatively affect healing and recovery. There is a good evidence-base for interventions which can improve sleep, however currently they are not being implemented into NHS practice. To address the evidence-practice gap, we have conducted early-phase development for an inpatient sleep intervention (ASLEEP); a multi-level intervention to improve inpatient sleep in UK hospital wards.

Methods: We used an iterative development process incorporating Patient and Public Involvement and Engagement, ward staff surveys and stakeholder consultations (orthopaedic and acute medicine), and theoretical mapping using behaviour change theories. Development took place in four stages: identification of existing patient-level intervention components to improve sleep in hospital; identification of environmental barriers and facilitators to sleep in hospital; consultation with health professional stakeholders; and final theoretical mapping using the COM-B model and Theoretical Domains Framework, also considering who holds 'change power' for each change construct.

Results: We identified 18 variables contributing to inpatient sleep, which are malleable to change universally across hospital wards. Central domains for change were identified as the ward environment context and resources; to reduce noise from equipment (material resources), and social influence; to modulate staff and patient noise awareness and behaviours (group norms). Change power mapping identified key stakeholders as patients, ward staff, procurement/estates, and NHS management.

Conclusions: Improving sleep in hospital requires a whole-systems approach which targets environmental factors, staff behaviour, and patient behaviour. We have provided recommendations for a multi-level intervention, highlighting core areas for change and essential stakeholders who must be involved to progress implementation. The next stage of development will involve operationalising recommendations and piloting, including evaluating mechanisms of change. It will be important to continue working with a broad range of stakeholders to bridge the evidence-practice gap and support sustainable practice adoption.