Perceived Barriers and Facilitators for Bedtime Routines in Families with Young Children

Abstract

Objectives: Bedtime routines are a highly recurrent family activity with important health, social and behavioural implications. This study examined perceived barriers to, and facilitators of, formulating, establishing, and maintaining optimal bedtime routines in families with young children.

Design: Participants completed a semi-structured interview based on the Theoretical Domains Framework (TDF). Analysis followed a deductive approach.

Participants: A total of 32 parents participated in the study. Most participants (N = 30) were females, were white (N = 25) and stay at home parents (N = 12).

Results: Key barriers included lack of appropriate knowledge and sources of information, problematic skills development, social influences, cognitive overload, and lack of motivation for change. Facilitators included social role, access to resources, positive intentions, beliefs about consequences and reinforcement. In particular, optimal bedtime routines were less likely to be enacted when parents were tired/fatigued and there was a strong effect of habit, with suboptimal routines maintained over time due to past experiences and a lack of awareness about the importance of a good bedtime routine.

Conclusions: Several theory-based, and potentially modifiable, determinants of optimal bedtime routines were identified in this study, providing important information for future interventions. Several of the key determinants identified were transient (tiredness) and/or non-conscious (habit), suggesting that future interventions may need to be deployed in real time, and should extend beyond conventional techniques.

Keywords: behavior change; child; parental; qualitative; sleep.

Figure 1

Schematic representation of key barriers and facilitators based on TDF. Flowchart presenting key barriers and facilitators identified by the study leading to the creation of sub-optimal bedtime routines.

Figure 2

A proposed mechanism for the initial creation and later maintenance of sub-optimal bedtime routines based on TDF results on ‘barriers and facilitators’ (Table 2). Sleep is a vital part of health and wellbeing with multiple and wide ranging implications for child development and wellbeing [2]. Sleep plays a major role for children’s development with poor sleep hygiene and sleeping habits associated with a series of problematic outcomes across physical health [27], neurocognitive development [28], socio-emotional development [29] and family functioning [30]. The importance of bedtime routines for sleep has been recently highlighted by a recommendation by the American Academy of Pediatrics (AAP) which issued a series of sleep health recommendation including the need of a consistent bedtime routine and childhood routines in general [2]. Apart from quality of sleep, sub-optimal bedtime routines could affect a series of other areas including dental health [6], school readiness and school performance [5,8] and BMI [9].