Abstract
Background: Ethnic inequities in sleep health exist from early in life. Existing recommendations and initiatives for improving children’s sleep are not always suitable for some Māori and Pacific whānau (families). Consequently, in the Moemoeā study, a multi-ethnic research team have worked together to develop a culturally relevant sleep and wellbeing intervention for diverse whānau with pēpi (infants) in Aotearoa New Zealand. The author of this thesis is positioned as a New Zealand European student researcher within the team.
Objectives: The first aim was to demonstrate how evidence from Western science could support the development of a culturally relevant sleep and wellbeing intervention for whānau with pēpi in Aotearoa New Zealand. The second aim was to contribute to the development of novel assessments and intervention strategies.
Methods: Two analyses of existing Western research were undertaken. The first was a systematic review and meta-analysis (SRMA) of the impact of sleep interventions on sleep duration in 0-5 year olds. The second was an exploratory moderation and mediation analysis in an effort to understand how a sleep intervention in infancy successfully reduced childhood obesity outcomes at age 2 years. Two new research projects were undertaken. The first was a qualitative exploration of sleep and parenting in ethnically diverse Pacific families (EDPF) in Aotearoa New Zealand. The second involved the development and testing of a new questionnaire to measure infant sleep health, and caregiver and whānau wellbeing, in Aotearoa New Zealand whānau.
Results: The SRMA identified 32 randomised controlled trials which reported a sleep duration outcome. The content of all interventions appeared to be predominantly based on knowledge from Western science. No intervention content that was specifically developed from Indigenous knowledge was identified. The findings of the moderation and mediation analysis, although exploratory, indicated that maternal ethnicity, and area-level socioeconomic deprivation, were potential moderators of the effect of a successful sleep intervention in infancy on obesity outcomes at age 2 years. The qualitative exploration of sleep and parenting in EDPF demonstrated that while practices within and between families were variable, overall families hoped to instil strong multi-cultural identities in their children and would welcome sleep resources which supported this. The testing of the newly developed questionnaire with 957 caregivers of 0-2 year old pēpi from diverse whānau indicated that caregiver perceptions of children’s sleep were a valid outcome measurement with small, yet consistent, positive associations with wellbeing.
Conclusions: Culturally relevant sleep and wellbeing interventions for whānau with pēpi have not been described in Western literature, but are necessary because those that have been developed from Western knowledge may not have equitable outcomes. As part of the development process, it is important to consider potential diversity among the families who may access such interventions. Caregiver perceptions of children’s sleep were positively associated with caregiver and whānau wellbeing in a diverse sample of Aotearoa New Zealand whānau and can be used as an important and relevant intervention outcome. In total, the findings within this thesis provide important support for the development of novel, culturally relevant sleep interventions.