Table 5 Educational interventions
Author | Intervention Description | Study Design / Analytical Approach | Intervention Delivery | Intervention Facilitator | Intervention Length | Data Time Points (PN = postnatal, GE = gestational) | Number of Participants (Intervention vs Control) | Retention Rate | Recruitment Sites and Methods | Mental Health Measures | Sleep Measures | Results Summary |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Galland et al. (2017), New Zealand [47] | Infant sleep education with four arms: control; sleep; food, activity and breastfeeding (FAB); combined (sleep and FAB) including group sessions, information booklet, consultant session and home visits for mothers and partners | Four armed RCT, between group | Face-to-face, group sessions and individual sessions at home | Researcher with infant sleep training and international board-certified lactation consultant | 2 (sleep), 4 (FAB) or 6 (combined) sessions over a max of 6 months | • Baseline (28–30 weeks GE) • 4 months PN • 6 months PN | 802 enrolled (205 FAB vs 192 Sleep vs 196 Combination vs 209 control) 784 completed (201 FAB vs 187 Sleep vs 189 Combination vs 207 control) | 98% | Maternity hospital | EPDS-10 | Sleep Qualitya Sleep Quantityb TST-S SOL-S | • No difference between groups for maternal sleep quantity or quality scores, duration or long sleep latency (≥30 min) • No difference between groups for depressive symptoms |
Hiscock et al. (2002), Australia [41] | Education on infant sleep and infant sleep problems with a sleep management plan involving controlled crying or ‘camping out’ | RCT, between group | Face-to-face individual sessions | Senior paediatric trainee with one year’s sleep management experience | 3 sessions fortnightly for 6 weeks | • Baseline (6–12 months PN) • 2 months after randomisation • 4 months after randomisation | 166 enrolled (78 vs 78) 164 completed (2 months) (76 vs 76) 156 completed (4 months) (75 vs 71) aSleep data is only reported on the last 57 recruited mothers | 99% (2 months) 94% (4 months) | Maternal and Child Health Centres | EPDS-10 | Sleep Qualityc Sleep Quantityd | • Intervention group more likely to have “very good” (sleep quality) and “enough” (sleep duration) at 2 months but no difference at 4 months • Depression scores did not differ between groups at 2 months, but after controlling for professional services, baseline depression score and group allocation the intervention group had greater improvement. No difference at 4 months • Subgroup with initial depression scores EPDS ≥10, greater improvement in the intervention group at 2 months and at 4 months |
Hiscock et al. (2007), Australia [48] | An individualised sleep management plan involving controlled crying or ‘camping out’, with handouts on infant sleep, infant sleep problems, dummies and overnight feeding | RCT, between group | Face-to-face individual sessions | Maternal and child health nurses trained by paediatrician and child psychologist | One phone consultation and one follow-up appt over 3 weeks | • Baseline (7 months PN) • 10 months PN • 12 months PN | 328 enrolled (174 vs 154) 319 completed (168 vs 151) | 97% | Invitations from Maternal and Child Health nurses | EPDS-10 SF-12 | Sleep Qualitye Sleep Quantityf | • Intervention group less poor and insufficient sleep at 12-months postnatal but not at 10-months postnatal • Intervention group had fewer depressive symptoms (EDPS) and better mental health score (SF-12) at 10- and 12-months postnatal • Intervention effect on depression symptoms at 10 months postnatal was greater for mothers with initial EPDS score was > 9 but no difference at 12-month postnatal |
Kempler et al. (2020), Australia [49] | Psychoeducation intervention including a booklet covering science behind sleep, normal sleep changes during pregnancy and postpartum, association between sleep and perinatal depression, infant sleep and settling routines, and strategies. | RCT, between group | Face-to-face group sessions | Sleep psychologist | Two 1.5-hour sessions for 2 weeks | • Baseline (third trimester) • Intervention end (6 weeks PN) • 4 months PN • 10 months PN | 215 enrolled (107 vs 108) 178 completed (89 vs 89) | 83% | Prenatal classes at large hospital, social media and word of mouth | EPDS-10 DASS-D DASS-A | PSQI-19 ISI-7 ESS-8 GSQ | • Intervention group better sleep quality and fewer insomnia symptoms at 4 months, but no difference at 6 weeks or 10 months postnatal • No difference between groups for daytime sleepiness • Control group almost twice as likely to score > 10 on the PSQI (no difference on scores > 5) • Control group 4 times more likely to meet criteria for clinical insomnia (ISI > 15) • Intervention group more likely to nap • No difference between groups for depression or anxiety |
Ladyman et al. (2020) New Zealand [29] | Trimester specific sleep education sessions and booklet covering general sleep and circadian information, how and why sleep changes in each trimester; and trimester-specific sleep support strategies. | Single arm, with an additional between group comparison | Face-to-face individual sessions | Sleep scientist | Three 45–90 min sessions over 24 weeks | • Baseline (0–14 weeks GE) • Intervention end (36 weeks GE) • 12 weeks PN | 15 intervention 76 matched controls | 68% (end of pregnancy) 64% (12 week follow up) | Online and traditional media and community advertisements | EPDS-10 EPDS-D EPDS-A | TST-24 GNS GSDS-21-T GSDS-SQ GSDS-MI GSDS-OI ESS-8 | • Intervention group better sleep quality and sleep continuity immediately post intervention, but no difference at 12-week postnatal • Intervention group better sleep latency immediately post intervention and at follow-up • No difference between groups for sleep duration and daytime sleepiness • Intervention group fewer depressive symptoms (total EPDS and depression subscale) immediately post intervention, but no difference 12-weeks postnatal • No difference between groups for anxiety symptoms |
Ozcan et al. (2020), Turkey [57] | Nursing care program containing information about breastfeeding, personal hygiene, fatigue, sleep, nutrition and Pilates exercises. | RCT, within and between group | Face-to-face individual sessions | Registered nurse | Eight 60–120 min sessions over 12 weeks | • Baseline (newly delivered) • Intervention end | 117 enrolled (58 vs 59) 110 completed (55 vs 55) | 94% | Hospital delivery room | WHOQOL-PH | PSQI-19 PSQI-SQ PSQI-SL PSQI-D PSQI-SE PSQI-SDis PSQI-SM PSQI-DD | • Improvements in pre-post sleep latency, duration, sleep disturbances and daytime disfunction (PSQI total score and respective subscales) (no difference in sleep quality and sleep efficiency) • Intervention group better sleep quality, sleep latency, sleep disturbances and daytime disfunction (PSQI total score and respective subscales) (no difference in sleep duration and sleep efficiency) • Intervention group mood remained stable while control group deteriorated |
Rouzafzoon et al. (2021), Iran [59] | Preventive behavioural sleep intervention (BSI) including infant sleep education and infant sleep strategies | RCT, between group | Face-to-face individual sessions and follow-up phone calls | Researcher/ midwife (lead author) | One 90 min session with weekly phone calls for 8 weeks | • Baseline (2–4 months PN) • Intervention end | 92 enrolled (41 vs 41) 83 completed (37 vs 36) | 90% | Health centres | EPDS-10 | PSQI-19 | • Improved intervention group sleep quality • Intervention group fewer depressive symptoms |
Skouteris et al. (2016), Australia [60] | Promotion of healthy lifestyle behaviours and mood management and body image issues that during pregnancy | RCT, between group | Face-to-face group and individual sessions | Trained health coach (an allied health professional) | One 1 hr. individual and one 2 hr. group sessions with weekly phone calls for 5 weeks | • Baseline (0–18 weeks GE) • 33 weeks GE (1 week post intervention) | 261 enrolled (130 vs 131) 172 completed (T2) (84 vs 96) 172 completed (T3) (75 vs 85) | 66% at T2 65% at T3 | Large antenatal clinic or small satellite clinic | EPDS-10 DASS-A | PSQI-19 | • Intervention group had better sleep quality post intervention • No difference between groups for depressive or anxiety symptoms |
Smart et al. (2007), Australia [61] | Consultation for mothers and partners on infant safety, infants’ behavioural sleep problems plus written management plan and follow up consultation | Single arm, pre-post | Face-to-face individual sessions | Paediatrician or trainee paediatrician | One 1 hr. session with follow-up appointment 2 weeks later | • Baseline (2 weeks-7 months PN) • 3 weeks (1 week after intervention end) | 72 enrolled 59 completed | 82% | Paediatric outpatient clinic | EPDS-10 | Sleep Quantityg Sleep Qualityh | • Improved sleep quality • No improvement for sleep quantity • Improved depressive symptoms and the number of women with clinically significant scores reduced |
Stremler et al. (2006), Canada [62] | Behavioural sleep educational intervention including education on maternal sleep hygiene and sleep support, infant sleep structure, issues and strategies | RCT, between group | Face-to-face individual session and follow-up phone calls | Study nurse | One 45-60 min session with 5 weekly phone calls for 5 weeks | • Baseline (newly delivered) • Intervention end | 30 enrolled (15 vs 15) 30 completed (15 vs 15) | 100% | Hospital postpartum unit | EPDS-10 EPDS-10- > 12 STAI-20-T STAI-20-Mod | GSDS-T-21 GSDS-PS TST-NA TST-DA TST-24-A Awak-A WASO-A LNSP-A SRSP | • Intervention group longer sleep durations • Fewer women in the intervention group rated their sleep as a problem • No difference between groups for sleep quality (GSDS), 24 hour or daytime TST, longest nocturnal sleep period, WASO or awakenings • No difference between groups for depression (EPDS) or anxiety (STAI) scores or clinically significant depression or anxiety scores |
Stremler et al. (2013), Canada [63] | Behavioural sleep educational intervention including education on maternal sleep hygiene and sleep support, infant sleep structure, issues and strategies | RCT, between group | Face-to-face individual session and follow-up phone calls | Sleep intervention nurse | One 45-60 min session with 3 weekly phone calls for 4 weeks | • Baseline (newly delivered) • Intervention end • 12 weeks PN | 246 enrolled (123 vs 123) 215 completed (110 vs 105) | 87% | Hospital postpartum unit | EPDS-10 | GSDS-T TST-NA Awak-A | • No differences between groups for sleep duration, quality (GSDS) or awakenings • No differences between groups for depressive symptoms |
Wilson et al. (2019), Australia [69] aNote: Same sample as below | Multidisciplinary intervention offering maternal and infant sleep opportunities, psychoeducation, medical and psychological support, and supervised practice implementing infant settling strategies | Single arm, pre-post | Residential program | Midwives, lactation consultants, nurses, psychologists, general practitioners, paediatricians, psychiatrists | 5 days residential program | • Baseline (2–23 months PN) • Intervention end | 85 enrolled 78 completed | 92% | Early parenting centre | EPDS-10 | TST-D SE-D Awak-D WASO-D SOL-D TSTNap-D PSQI-19 CIRENS-2 ESS-8 KSS-1 | • Improved sleep efficiency, awakenings, WASO, SOL, sleep quality, daytime sleepiness and KSS but not sleep duration) • Improved depressive symptoms |
Wilson et al. (2019), Australia [70] aNote: Same sample as above | Multidisciplinary residential intervention offering maternal and infant sleep opportunities, psychoeducation, medical and psychological support, and supervised practice implementing infant settling strategies. | Single arm, pre-post | Residential program | Midwives, lactation consultants, nurses, psychologists, general practitioners, paediatricians, psychiatrists | 5 days | • Baseline (2–23 months PN) • Intervention end | 85 enrolled 78 completed | 92% | Early parenting centre | DASS-D DASS-A DASS-S IDA-I-6 | ISI-7 TST-D | • Improved insomnia symptoms (ISI) but not sleep duration • Improved depressive and anxiety symptoms (DASS subscales) and irritability symptoms (IDA-I) |
Zhao et al. (2017), China [73] | Couple-separated psychoeducational workshops for first-time parents. Five sessions for mothers on maternal mental health and the last session specific for husbands | RCT, between group | Face-to-face group sessions | Midwives (with psychological research experience) | Six 1.5 hr. sessions for 6–12 weeks | • Baseline (0–28 weeks GE) • 42 days PN | 352 enrolled (176 vs 176) 334 completed (167 vs 167) | 95% | Obstetrics and gynecology hospital antenatal clinic | EPDS PDSS | TST-S | • Intervention group longer sleep durations • Intervention group less minor (EPDS 9–12 or PDSS 60–79) and major (EPDS ≥13 or PDSS ≥80) depression |
Zhao et al. (2020), China [74] | Psychoeducational workshops for first-time parents focused on perinatal mental health and breastfeeding | RCT, between group | Face-to-face group sessions | Midwives (certified lactation consultant with psychological research experience) | Four 60 min sessions for 4–8 weeks | • Baseline (28–35 weeks GE) • 3 days PN | 182 enrolled (91 vs 91) 180 completed (91 vs 89) | 99% | Maternal hospital antenatal clinic | EPDS-10 | TST-S | • Intervention group longer sleep durations • Intervention group fewer depressive symptoms |