Self-efficacy-based web and mobile intervention to improve infant sleep: Randomized trial with Brazilian mothers

To evaluate the effectiveness of a web-based educational intervention, grounded in self-efficacy theory, on the sleep quality of infants aged 10-24 months by reducing nighttime awakenings and increasing total nighttime sleep duration.

A randomized controlled trial was conducted with 104 Brazilian mother-infant dyads allocated to either an intervention group (IG) or control group (CG). The IG received a structured educational intervention delivered by a sleep specialist researcher, consisting of two online sessions (50 and 30 min, respectively), combined with 30 daily motivational messages sent via WhatsApp over a 30-day period. The educational content addressed sleep hygiene, routines, sleep onset independence, and the "camping-out" technique, all based on the self-efficacy theoretical framework. Sleep outcomes were assessed using the Brief Infant Sleep Questionnaire (BISQ) at baseline, 15 days, and 30 days. Data were analyzed using repeated measures and a significance level of p < 0.05.

At baseline, infants in the IG had a mean nighttime sleep duration of 8.2 (±2.1) hours and 4.7 (±1.8) nighttime awakenings, while those in the CG had 8.6 (±1.6) hours and 4.1 (±1.1) awakenings. After 30 days, the IG showed a significant improvement, with an increase in total nighttime sleep duration to 11.2 (±0.7) hours (d = 1.96) and a reduction in nighttime awakenings to 0.5 (±0.6) (d = -3.31), compared to the CG, which remained at 8.5 (±1.3) hours and 3.7 (±1.0) awakenings. Moreover, by the end of the study, 90.9 % of infants in the IG were falling asleep independently, compared to 12 % in the CG (d = 2.63). All values are reported as mean ± standard deviation (SD).

The web-based educational intervention, led by a sleep specialist and reinforced by mobile messaging, was effective in improving infant sleep quality. These findings support the feasibility of combining synchronous and asynchronous digital strategies to address behavioral sleep problems in early childhood, particularly in settings with limited access to in-person care.

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