The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting

Abstract

Objectives: To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended care setting.

Design: Cluster randomized trial.

Setting: Extended-care (nursing) facilities.

Participants: US employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings.

Intervention: The Work, Family and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision.

Measurements: Primary actigraphic outcomes included: total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms and sleep quality. Measures were obtained at baseline, 6-months and 12-months post-intervention.

Results: A total of 1,522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared to control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (p=0.040), where younger employees benefited more from the intervention.

Conclusion: In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees' sleep outcomes benefited more from the intervention.

Figure 1

Flow diagram of study recruitment and retention.

Figure 2. Venn Diagram of the sleep deficiency in the study population at baseline for employees and managers

Sleep deficiency at baseline (inadequate sleep quality and/or insufficient sleep duration) was defined as having ≥ 1 of the following components: Wake after Sleep Onset (WASO) > 45 minutes per main sleep period (measured using wrist actigraphy and suggestive of insomnia), self-reported sleep insufficiency (never or rarely feeling rested upon waking) and/or mean actigraphically-measured total sleep time < 6.5 hours per 24 hours.

Figure 3. Adjusted model nighttime sleep profiles across age groups for employees

Points represent the mean and bars represent 95% confidence intervals. Test of moderation by age (p=0.040). Note: Test for moderation was performed using adaptations of the generalized linear mixed models testing intervention effects by including a three-way interaction of age with time and intervention condition. P-value reflects the global test of the three-way interaction regression coefficients.