Intervention Through Application User Group Accessed on Smartphones: Effects to Sleep Quality

Background: Sleep quality plays an important role in the overall health of nurses, and poor sleep quality can be comorbid with many other physical or mental disorders, which may influence the quality of patient care provided by nurses. The LINE messaging app is a commonly used tool for sending messages easily and quickly. Furthermore, a religious form of meditation is a safe and easy-to-learn meditation technique that can reduce job stress. Therefore, to improve sleep quality among nurses, we designed and implemented an intervention with modified transcendent meditation (MTM), which is religious form of meditation, through a LINE user group. In this study, we incorporated an element of religious belief into meditation—called modified TM (MTM). The feature of MTM is voicelessly speaking the Holy Name of God in the mind. Based on the aforementioned results, whether MTM exerts effects on nurses working in shifts is our concern. Therefore, this study aimed to confirm the positive effects of MTM on sleep quality and psychological detachment.

Objective: This study evaluated whether the MTM intervention delivered through a LINE user group effectively improved sleep quality and lessened anxiety and depression resulting from job stress in nurses.

Methods: A sample of 84 nurses with poor sleep quality (Chinese version of Pittsburgh Sleep Quality Index [CPSQI] > 5) and psychological problems (Chinese version of Hospital Anxiety and Depression Scale [CHADS] ≥ 8) were randomly assigned to the MTM intervention group (IG) and control group (CG; no MTM intervention). Self-report data were collected at intervals of 2 weeks continually to 12 weeks and then during the extended 12-week follow-up. Multiple repeated measures were used to evaluate the change in CPSQI and CHADS scores between the IG and CG. Regression analysis was used to predict the effects of anxiety and depression in the CPSQI score.

Results: The anxiety and depression scores of the IG were significantly different at 6 weeks. The CHADS scores of the IG were continually decreased at 8 weeks. However, the CPSQI scores of IG had not changed significantly until 8 weeks of MTM intervention had been completed. Theses evidences were not found in the CG. The MTM intervention changed anxiety and depression scores before changing the CPSQI score. The MTM intervention directly exerted positive effects on sleep quality, anxiety, and depression. The mechanism of MTM improves sleep quality through reduction of depression. The effects of MTM for improving sleep quality, anxiety and depression were maintained for 12 weeks under naturalistic extension. In addition, this study demonstrated that LINE user groups may be highly useful tools for delivering self-help intervention in health care.

Conclusions / Implications

Our data suggest that the MTM intervention, implemented through a LINE user group, exerts a positive effect on sleep quality, anxiety, and depression, which can be a substantial benefit for nurses. Nurses should use MTM, which is simple and easy to learn, as a coping strategy because it is a safe and cheap method that can be used to improve sleep quality and increase psychological detachment. In addition, this study demonstrated that LINE user groups may be highly useful tools for delivering self-help intervention in health care.