title: Attitudes, beliefs, and perceptions of caregivers and rehabilitation providers about disabled children's sleep health: a qualitative study.
abstract: BACKGROUND
  Children with disabilities are more likely to have sleep disturbances than children without disabilities. Identifying attitudes, beliefs, knowledge, and perceptions of caregivers and health professionals is essential in developing effective intervention programs to improve disabled children's sleep health. However, no such qualitative data about adults who have key roles in the life and daytime activities of children with disabilities are available. This qualitative study aimed to understand attitudes, beliefs, knowledge, and perceptions about disabled children's sleep hygiene among caregivers and rehabilitation providers of children with disabilities.
  
  
  METHODS
  Twenty seven adults, including nine primary caregivers and eighteen rehabilitation providers, participated in five focus group discussions between September and December 2012 at the Rehabilitation Center in Punta Arenas, Chile. A trained facilitator guided focus group discussions using a semi-structured script. Audiotapes and transcripts of focus group discussions were reviewed and analyzed for recurrent themes.
  
  
  RESULTS
  Participants identified seven themes related to children's sleep hygiene: lifestyle behaviors, family factors, children's disabilities and/or comorbidities, environmental factors, adults' responsibilities for children's sleep, perception of good sleep, and parental distress about children's sleep problems. While both caregivers and rehabilitation providers recognized the importance of sleep for children's health and functioning, they differed in their understanding of how sleep hygiene practices influence sleep. Rehabilitation providers recognized the negative influence of electronics on sleep and the positive influence of sleep routines. In contrast, caregivers reported use of television/movie watching and stimulants as coping strategies for managing children's sleep problems.
  
  
  CONCLUSIONS
  Caregivers may benefit from better understanding the influence of electronics and stimulant use on child sleep health. Rehabilitation providers are well positioned to provide educational messages to both children and caregivers in order to change their attitudes, perceptions, and practices surrounding sleep. These qualitative data are valuable in developing intervention programs aimed at improving sleep health among children with disabilities.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. xchen@hsph.harvard.edu.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Chen
authors.forename: Bizu
authors.initials: B
authors.lastname: Gelaye
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Velez
authors.forename: Micah
authors.initials: M
authors.lastname: Pepper
authors.forename: Sara
authors.initials: S
authors.lastname: Gorman
authors.forename: Clarita
authors.initials: C
authors.lastname: Barbosa
authors.forename: Ross D
authors.initials: RD
authors.lastname: Zafonte
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D017028:Caregivers; D002648:Child; D019988:Children with Disabilities; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012046:Rehabilitation; D012890:Sleep; D012893:Sleep Wake Disorders / Q000517:prevention & control; D012931:Social Environment; D013690:Television