Delivery of interventions across the socioecological model to improve adolescent sleep: A mixed-methods systematic...

Adolescent sleep health is influenced by a complex interplay of intrapersonal, interpersonal, institutional, community, and policy factors, yet most interventions target individual behavior alone, limiting population-level impact. This mixed-methods systematic review examined the socioecological levels addressed by adolescent sleep interventions, their effectiveness in improving sleep quality and duration, and the barriers and facilitators affecting feasibility, acceptability, and implementation. Five databases(2003-2025) were searched for studies involving adolescents aged 10 to 19 years, participating in interventions aimed at preventing poor sleep or improving sleep quality and/or duration. A segregated convergent design was used to synthesize quantitative data assessing effectiveness with vote-counting and qualitative data thematically analyzed in parallel. Findings were narratively reported. Fifty-three studies met the inclusion criteria. Most (72%) targeted a single socioecological level, primarily intrapersonal components such as sleep education and therapeutic approaches. Interventions delivered across one (n = 37), two (n = 10), and three levels (n = 6) showed the most consistent improvements in sleep duration when targeting two levels, with significant effects observed in 70%, 80%, and 50% of studies, respectively. A similar pattern was observed for sleep quality, with significant improvements reported in 67%, 80%, and 25% of interventions, respectively. Qualitative synthesis identified several cross-cutting influences on implementation, including intervention burden, the importance of personalized components, and the need for coproduction and stakeholder engagement. The findings demonstrate persistence of single-level, individually focused interventions and a limited use of multilevel approaches designed to address broader determinants of sleep health. Designing and evaluating interventions that integrate individual, interpersonal, organizational, and policy components may offer greater potential to improve adolescent sleep health at scale.