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      Sleep hygiene behaviours mediate the association between health/e‐health literacy and mental wellbeing

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          Abstract

          Background

          Health literacy and e‐health literacy are important factors helping people shape awareness of health behaviours in different aspects, including sleep hygiene behaviours. Good sleep hygiene behaviours promote sleep quality and are beneficial to overall mental wellbeing.

          Objective

          We aimed to examine if sleep hygiene behaviours may mediate the association between health literacy/e‐health literacy and mental wellbeing.

          Methods

          Adult Iranian subjects ( n = 9775; mean [SD] age = 36.44 [11.97] years; 67.3% females) completed the Health Literacy Instrument for Adults, eHealth Literacy Scale, three items on sleep hygiene behaviour that have been used in prior research and the Short Warwick Edinburgh Mental Wellbeing Scale. Data were then subjected to structural equation modelling (SEM) including 500 bootstrapping resampling to examine whether sleep hygiene is a mediator in the relationship between health literacy/e‐health literacy and mental wellbeing.

          Findings

          Both health literacy and e‐health literacy were significantly associated with mental wellbeing ( r = .63 for health literacy and .39 for e‐health literacy; p < .001) and sleep hygiene behaviours ( r = .58 for health literacy and .36 for e‐health literacy; p < .001). Sleep hygiene behaviours were significantly associated with mental wellbeing ( r = .42; p < .001). Moreover, SEM that incorporated bootstrapping approaches indicated that sleep hygiene behaviours were significant mediators in the association between health literacy/e‐health literacy and mental wellbeing.

          Conclusions

          We conclude that health literacy and e‐health literacy are associated with mental health wellbeing in the Iranian population. Additionally, the association could be mediated via sleep hygiene behaviours.

          Patient or Public Contribution

          The study was co‐designed with healthcare providers from the vice‐Chancellor's Office for Health Affairs of Qazvin University of Medical Sciences as equal partners. Moreover, the women's health volunteers were involved in the design of the study.

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          The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation

          Ruth Tennant, Louise Hiller, Ruth Fishwick … (2007)
          Background There is increasing international interest in the concept of mental well-being and its contribution to all aspects of human life. Demand for instruments to monitor mental well-being at a population level and evaluate mental health promotion initiatives is growing. This article describes the development and validation of a new scale, comprised only of positively worded items relating to different aspects of positive mental health: the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Methods WEMWBS was developed by an expert panel drawing on current academic literature, qualitative research with focus groups, and psychometric testing of an existing scale. It was validated on a student and representative population sample. Content validity was assessed by reviewing the frequency of complete responses and the distribution of responses to each item. Confirmatory factor analysis was used to test the hypothesis that the scale measured a single construct. Internal consistency was assessed using Cronbach's alpha. Criterion validity was explored in terms of correlations between WEMWBS and other scales and by testing whether the scale discriminated between population groups in line with pre-specified hypotheses. Test-retest reliability was assessed at one week using intra-class correlation coefficients. Susceptibility to bias was measured using the Balanced Inventory of Desired Responding. Results WEMWBS showed good content validity. Confirmatory factor analysis supported the single factor hypothesis. A Cronbach's alpha score of 0.89 (student sample) and 0.91 (population sample) suggests some item redundancy in the scale. WEMWBS showed high correlations with other mental health and well-being scales and lower correlations with scales measuring overall health. Its distribution was near normal and the scale did not show ceiling effects in a population sample. It discriminated between population groups in a way that is largely consistent with the results of other population surveys. Test-retest reliability at one week was high (0.83). Social desirability bias was lower or similar to that of other comparable scales. Conclusion WEMWBS is a measure of mental well-being focusing entirely on positive aspects of mental health. As a short and psychometrically robust scale, with no ceiling effects in a population sample, it offers promise as a tool for monitoring mental well-being at a population level. Whilst WEMWBS should appeal to those evaluating mental health promotion initiatives, it is important that the scale's sensitivity to change is established before it is recommended in this context.
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            eHEALS: The eHealth Literacy Scale

            Cameron Norman, Harvey A Skinner (2006)
            Background Electronic health resources are helpful only when people are able to use them, yet there remain few tools available to assess consumers’ capacity for engaging in eHealth. Over 40% of US and Canadian adults have low basic literacy levels, suggesting that eHealth resources are likely to be inaccessible to large segments of the population. Using information technology for health requires eHealth literacy—the ability to read, use computers, search for information, understand health information, and put it into context. The eHealth Literacy Scale (eHEALS) was designed (1) to assess consumers’ perceived skills at using information technology for health and (2) to aid in determining the fit between eHealth programs and consumers. Objectives The eHEALS is an 8-item measure of eHealth literacy developed to measure consumers’ combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. The objective of the study was to psychometrically evaluate the properties of the eHEALS within a population context. A youth population was chosen as the focus for the initial development primarily because they have high levels of eHealth use and familiarity with information technology tools. Methods Data were collected at baseline, post-intervention, and 3- and 6-month follow-up using control group data as part of a single session, randomized intervention trial evaluating Web-based eHealth programs. Scale reliability was tested using item analysis for internal consistency (coefficient alpha) and test-retest reliability estimates. Principal components factor analysis was used to determine the theoretical fit of the measures with the data. Results A total of 664 participants (370 boys; 294 girls) aged 13 to 21 (mean = 14.95; SD = 1.24) completed the eHEALS at four time points over 6 months. Item analysis was performed on the 8-item scale at baseline, producing a tight fitting scale with α = .88. Item-scale correlations ranged from r = .51 to .76. Test-retest reliability showed modest stability over time from baseline to 6-month follow-up (r = .68 to .40). Principal components analysis produced a single factor solution (56% of variance). Factor loadings ranged from .60 to .84 among the 8 items. Conclusions The eHEALS reliably and consistently captures the eHealth literacy concept in repeated administrations, showing promise as tool for assessing consumer comfort and skill in using information technology for health. Within a clinical environment, the eHEALS has the potential to serve as a means of identifying those who may or may not benefit from referrals to an eHealth intervention or resource. Further research needs to examine the applicability of the eHEALS to other populations and settings while exploring the relationship between eHealth literacy and health care outcomes.
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              Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials

              Alexander Scott, Thomas Webb, Marrissa Martyn-St James … (2021)
              The extent to which sleep is causally related to mental health is unclear. One way to test the causal link is to evaluate the extent to which interventions that improve sleep quality also improve mental health. We conducted a meta-analysis of randomised controlled trials that reported the effects of an intervention that improved sleep on composite mental health, as well as on seven specific mental health difficulties. 65 trials comprising 72 interventions and N  = 8608 participants were included. Improving sleep led to a significant medium-sized effect on composite mental health ( g+  = −0.53), depression ( g+  = −0.63), anxiety ( g+  = −0.51), and rumination ( g+  = −0.49), as well as significant small-to-medium sized effects on stress ( g+  = −0.42), and finally small significant effects on positive psychosis symptoms ( g+  = −0.26). We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. Our findings suggest that sleep is causally related to the experience of mental health difficulties. Future research might consider how interventions that improve sleep could be incorporated into mental health services, as well as the mechanisms of action that explain how sleep exerts an effect on mental health.
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                Author and article information

                Contributors
                David Gozal: Role: Professor
                Chung‐Ying Lin:
                ORCID: http://orcid.org/0000-0002-2129-4242
                Role: Associate Professorcylin36933@gmail.com
                Amir H. Pakpour:
                ORCID: https://orcid.org/0000-0002-8798-5345
                Role: Professoramir.pakpour@ju.se
                Journal
                Journal ID (nlm-ta): Health Expect
                Journal ID (iso-abbrev): Health Expect
                Journal ID (doi): 10.1111/(ISSN)1369-7625
                Journal ID (publisher-id): HEX
                Title: Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 1369-6513
                ISSN (Electronic): 1369-7625
                Publication date (Electronic): 07 August 2023
                Publication date Collection: December 2023
                Volume: 26
                Issue: 6 ( doiID: 10.1111/hex.v26.6 )
                Pages: 2349-2360
                Affiliations
                [ 1 ] Social Determinants of Health Research Center, Research Institute for Prevention of Non‐Communicable Diseases Qazvin University of Medical Sciences Qazvin Iran
                [ 2 ] Department of Child Health University of Missouri School of Medicine Columbia Missouri USA
                [ 3 ] Institute of Allied Health Sciences, College of Medicine National Cheng Kung University Tainan Taiwan
                [ 4 ] Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University Tainan Taiwan
                [ 5 ] Department of Public Health, College of Medicine National Cheng Kung University Tainan Taiwan
                [ 6 ] Department of Occupational Therapy, College of Medicine National Cheng Kung University Tainan Taiwan
                [ 7 ] Department of Nursing, School of Health and Welfare Jönköping University Jönköping Sweden
                Author notes
                [*] [* ] Correspondence Chung‐Ying Lin, PhD, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.

                Email: cylin36933@ 123456gmail.com

                Amir H. Pakpour, PhD, Social Determinants of Health Research Center, Research Institute for Prevention of Non‐Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran; Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping 55111, Sweden.

                Email: amir.pakpour@ 123456ju.se

                Author information
                http://orcid.org/0000-0002-2129-4242
                https://orcid.org/0000-0002-8798-5345
                Article
                Publisher ID: HEX13837
                DOI: 10.1111/hex.13837
                PMC ID: 10632637
                PubMed ID: 37551056
                SO-VID: 99374181-9c0c-4359-9fed-48401e9a06f6
                Copyright © © 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 19 July 2023
                Date received : 30 March 2023
                Date accepted : 21 July 2023
                Page count
                Figures: 4, Tables: 23, Pages: 12, Words: 6361
                Funding
                Funded by: Qazvin University of Medical Sciences , doi 10.13039/501100006396;
                Award ID: 28/20/21682
                Categories
                Subject: Original Article
                Subject: Original Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date December 2023
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.4 mode:remove_FC converted:09.11.2023

                ScienceOpen disciplines: Health & Social care
                Keywords: e‐health,health literacy,iran,mental wellbeing,sleep behaviour
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: e‐health, health literacy, iran, mental wellbeing, sleep behaviour

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