A peer influence approach to reduce night-time use of interactive electronic devices and social media among adolescents (CLOCK OFF): intervention development using causal loop diagrams

Background: There has been a shift towards reduced sleep among young people which has recognised negative impacts on health and wellbeing. One factor contributing to delayed bedtimes and disrupted sleep is night-time use of interactive electronic devices (IEDs), including for social media. Peers can be a key influence on night-time IED use, particularly through social pressure to be online and fear of missing out. Conversely, peer influence can successfully be harnessed to improve the health behaviour of young people. The aim of this study was to co-develop and refine a programme theory to inform a future intervention to reduce night-time IED and social media use among adolescents.

Methods: Eighteen young people (mean age 13) were recruited from three schools to take part in online workshops. Each participant attended four facilitated workshops. Workshops were 90 minutes long and held during school hours via MS-Teams. Workshop one was a group casual loop diagram (CLD) exercise. Remaining workshops focused discussions on pre-established interventions (ASSIST, #SLEEPYTEENS, SleepScotland Peer-Mentor) and review of a draft logic model. Workshops were analysed using thematic approaches.

Results: Analyses of the CLD identified causal influences in IED use at different levels (i.e. individual, social, institutional), and key leverage points for potential intervention. Young people are aware of the importance of sleep and tackling problematic IED use. However, changing night-time IED habits may not be a high priority for some. For future intervention to be successful, communication, trust and relationships between young people, teachers and parents are vital. Knowledge and awareness were highlighted as the main outcome that could be achieved, more so than improved sleep.

Conclusions and implications: Conducting rapid collaborative and soft systems methods online with young people in school settings is a novel and feasible approach. Findings will inform the development of an intervention and revised programme theory.