The development and feasibility of Sleepful Drive, a digital CBT for insomnia programme to improve sleep quality in commercial drivers

The Medical Research Council awarded funding for the project titled “The Co-development of a comprehensive sleep management programme in commercial drivers”.The aim of this project package was to feasibility test the co-created app-based intervention to improve sleep quality and quantity in commercial drivers within the road freight sector.Research Objectives:One of the main objectives of the project was to test the feasibility of the prototype Sleepful Drive in real occupational settings. The research questions for this part of the project therefore were:1. Is Sleepful Drive functionally sound?2. Is Sleepful Drive feasible in a group of intended users, in real occupational settings, as measured by recruitment, retention, and engagement with the app?3. Is Sleepful Drive efficacious in improving sleep quality, as measured by baseline and post-intervention indicators?Research Design and Method:1. Functionality testingFunctionality testing was conducted through iterative steps as follows: (1) user experience experts who ensured that content and functionality met WCAG 2.2 AA standards for being perceivable, operable, understandable and robust; (2) the list of tasks containing the functions of the app was ‘live’ tested by commercial drivers using “think-aloud” methods for feedback in real-time; and (3) this iteration was then functionality tested by 20 commercial drivers who download the Sleepful Drive prototype to their personal smartphone and used the app for 2 to 3 weeks. Participants provided feedback on the content, perceived relevance, practical application and structure of the app. The final iteration of the app was then forwarded for the next step, feasibility testing.2. Feasibility testingThe feasibility trial was conducted in real-life occupational settings. Outcome metrics addressed recruitment, retention, and engagement with the app while baseline and post-intervention measures provided early indicators of efficacy. Participants were HGV or commercial van drivers responsible for transporting goods with at least 1 year of experience, who owned a smart phone (i-phone or android), experienced sleep difficulties (as identified at screening using the Single Item Sleep Quality Scale; Snyder et al, 2018), and provided full informed consent for participation. Eligible drivers were then asked to download the Sleepful Drive prototype on to their smartphone and use the app for at least 4 weeks. 48 male commercial drivers submitted baseline measures, 36 completed the intake assessment and registered to use the app, and 30 completed the follow-up measures. The baseline and post questionnaires included detailed assessments of sleep health, hyperarousal, anxiety, general health, and fatigue. The outcome measures included app utility and accessibility, using a 5-point Likert scale. App engagement data, derived from platform metrics, included: average time spent on the app (number of log-ins); average number of completed sleep diary entries; and average number of daily feeling refreshed/fatigued data points provided. Indicators of app efficacy were provided by ratings of TST, sleep onset latency, and time awake entered daily into the app sleep diary. All data was analysed using SPSS Statistics Package 29.0.1 (IBM, Armonk, NY, USA). Continuous variables were compared using univariate analysis of covariance (ANCOVA) models with time (baseline-follow-up) as grouping factors, and age as a between-subject factor. Linear regression models examining the trend in sleep duration, sleep onset latency, time awake, sleep efficiency and daytime alertness over time were fitted with the consecutive 45 days of app use as predictor, and daily average for that variable as dependent.© the authors