Effectiveness of an internet-based intervention to improve sleep difficulties in a culturally diverse sample of international students: A randomised controlled pilot study

Kerstin Spanhel; Daniela Burdach; Teresa Pfeiffer; Dirk Lehr; Kai Spiegelhalder; David D Ebert; Harald Baumeister; Juergen Bengel; Lasse B Sander

doi:10.1111/jsr.13493

Effectiveness of an internet-based intervention to improve sleep difficulties in a culturally diverse sample of international students: A randomised controlled pilot study

J Sleep Res. 2022 Apr;31(2):e13493. doi: 10.1111/jsr.13493. Epub 2021 Sep 22.

Authors

Kerstin Spanhel¹, Daniela Burdach¹, Teresa Pfeiffer¹, Dirk Lehr², Kai Spiegelhalder³, David D Ebert⁴, Harald Baumeister⁵, Juergen Bengel¹, Lasse B Sander¹

Affiliations

¹ Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
² Department of Health Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany.
³ Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Psychology und Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
⁵ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany.

PMID: 34549852
DOI: 10.1111/jsr.13493

Abstract

Sleep difficulties are widespread among international students. Internet-based interventions are suggested as a low-threshold treatment option but may require cultural adaptation among culturally diverse populations. The present pilot study investigated the effectiveness and acceptance of an internet-based intervention to improve sleep difficulties in international students. A total of 81 international students of 36 nationalities were randomly assigned to the intervention (n = 41) or waitlist control group (n = 40). The intervention group received immediate access to a culturally non-adapted unguided internet-based sleep intervention consisting of three modules based on sleep hygiene and cognitive techniques to reduce rumination. At baseline, 4 and 12 weeks after randomisation, insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, depression, anxiety, perceived stress, well-being, presenteeism, mental health literacy) were assessed. Data were analysed using linear multi-level analyses. Additionally, satisfaction and perceived cultural appropriateness of the intervention were evaluated by international students after 4 weeks, and compared with ratings of German students, who represent the original target group. Insomnia severity improved over time in the intervention group compared to the control group, revealing a significant estimated mean difference of -5.60 (Hedges' g = 0.84, p < 0.001) after 12 weeks. Satisfaction and perceived cultural appropriateness was high and comparable to that of German students. The present study shows that a culturally non-adapted internet-based sleep intervention can be a low-threshold treatment option to help meet the high demand for mental healthcare among international students. It thus indicates that cultural adaptation might not represent a precondition for providing effective internet-based sleep interventions to this target group.

Keywords: culturally sensitive treatment; eHealth; insomnia; mental health treatment gap.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Internet
Internet-Based Intervention*
Pilot Projects
Sleep
Sleep Initiation and Maintenance Disorders*
Students / psychology
Treatment Outcome