Sleep and quality of life in urban poverty: the effect of a slum housing upgrading program

Abstract

Study objectives: To evaluate the effect of a housing transition on sleep quality and quality of life in slum dwellers, participating in a slum housing upgrading program.

Design: Observational before-and-after study with a convergent-parallel mixed method design.

Setting: Five slums located in the metropolitan area of Buenos Aires, Argentina.

Participants: A total of 150 slum dwellers benefited by a housing program of the nonprofit organization TECHO (spanish word for "roof").

Interventions: Participants moved from their very low-quality house to a basic prefabricated 18 m(2) modular house provided by TECHO.

Measurements and results: The Pittsburgh Sleep Quality Index (PSQI) and World Health Organization Quality of Life brief scale (WHOQOL-BREF) were administered before and after housing upgrading. Data about housing conditions, income, education, sleeping conditions, and cardiovascular risk were also collected. Semistructured interviews were used to expand and nuance quantitative data obtained from a poorly educated sample. Results showed that sleep quality significantly increased after the housing program (z = -6.57, P < 0.001). Overall quality of life (z = -6.85, P < 0.001), physical health domain (z = -4.35, P < 0.001), psychological well-being domain (z = -3.72, P < 0.001) and environmental domain (z = -7.10, P < 0.001) of WHOQOL-BREF were also improved. Interviews demonstrated the importance of serenity for improving quality of life.

Conclusions: A minimal improvement in the quality of basic housing can significantly increase sleep quality and quality of life among slum dwellers. Understanding sleep and daily life conditions in informal urban settlements could help to define what kind of low-cost intervention may improve sleep quality, quality of life, and reduce existent sleep disparity.

Keywords: Sleep; mixed method design; poverty; quality of life; slums.

Figure 1

Flowchart of research. Phase 1 involved acquiring quantitative data before housing upgrade. Phase 2 involved acquiring quantitative data at 1 and 6 mo after house upgrade took place. During that period qualitative data was obtained through semistructured interviews.

Figure 2

The serenity cycle (“El ciclo tranquilo”). Improved housing conditions provoke feelings of safety and serenity on the participants that affects on sleep, social interactions and daily routine. These changes affect quality of life, motivating them to move on.