Empowering Community Health Cadres Through Sleep Hygiene Education to Promote Healthy Sleep Among Older Adults

Abstract

Background: Sleep problems are common among older adults and may adversely affect health, daily functioning, and well-being. Community health cadres are strategically positioned to promote healthy sleep practices because of their close interaction with older adults and their families. Strengthening cadres’ knowledge of sleep hygiene is therefore important for supporting community-based sleep health promotion.

Objective: This community engagement program aimed to strengthen community health cadres’ knowledge of sleep quality and sleep hygiene among older adults and to identify specific learning gaps requiring further educational reinforcement.

Methods: The Healthy Sleep Care Cadres for Older Adults program was conducted at Padamukti Community Health Center, Bandung Regency, Indonesia. A total of 51 community health cadres participated in the program. The activities comprised baseline knowledge assessment, health education, cadre capacity building, and post-program evaluation. Educational content covered sleep and sleep quality, consequences of insufficient sleep, sleep hygiene, six pillars of healthy sleep practices, signs of sleep problems, referral indications, and cadres’ roles in supporting older adults. Knowledge was assessed using a 15-item questionnaire with a total score ranging from 0 to 15. Descriptive statistics and item-level changes in correct responses were analyzed. Because individual pre- and post-test data could not be matched, score distributions were compared using the Mann–Whitney U test.

Results: The mean knowledge score increased descriptively from 12.16 ± 3.21 at pre-test to 13.31 ± 1.69 at post-test. The proportion of cadres with good knowledge increased from 66.7% to 80.4%, while the proportion with poor knowledge decreased from 7.8% to 0%. Correct-response proportions increased for 11 of 15 items (73.3%). The largest improvements were observed for knowledge regarding foods to avoid before bedtime (+23.5 percentage points) and mobile phone or television use before sleep (+21.6 percentage points). Age-related changes in sleep and selected aspects of physical activity remained important learning gaps. The Mann–Whitney U test yielded U = 1034.5; p = 0.070, indicating that the difference in score distributions did not reach statistical significance.

Conclusion: The program was followed by a favorable descriptive shift in cadres’ knowledge and identified specific learning gaps for future educational reinforcement. These findings support further development of the program from one-time education toward sustained cadre capacity building incorporating practical education skills, early identification of sleep problems, referral, mentoring, and evaluation of sleep-health outcomes among older adults.