Social determinants of preschoolers' sleep health in Aotearoa/New Zealand : a mixed methods study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand

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Massey University
Sleep is important for young children’s health and wellbeing. In Aotearoa/New Zealand ethnic and socioeconomic inequities exist in adult sleep, however little is known about the social determinants of young children’s sleep and whether sleep inequities exist in early childhood. A mixed methods study was conducted to address this gap in knowledge. Kaupapa Māori epidemiological principles informed the study design and sleep was viewed through a social determinants of health and complementary socioecological theoretical lens. Sleep and sociodemographic questionnaire data from 340 Māori and 570 non-Māori preschoolers in the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study (Moe Kura) were analysed. Log-binomial regression models investigated independent associations between ethnicity, socioeconomic position (SEP) and preschoolers’ sleep duration, timing and problems. Ethnicity and socioeconomic deprivation were independently associated with short sleep duration (<10hrs), week/weekend sleep duration difference >1hr, later bedtimes and sleep problems based on a number of maternal-report measures. A sub-sample of Moe Kura mothers (15 Māori and 16 non-Māori with low and high SEP) participated in face-to-face interviews about their preschooler’s sleep. Results from thematic analysis identified four themes relating to mothers’ perceptions of preschooler sleep: ‘child happiness and health’, ‘maternal wellbeing’, ‘comfort and connection’ and ‘family functioning and harmony’. Four additional themes centred around facilitators and barriers to preschoolers sleeping well: ‘health, activity and diet’, ‘sleep promoting physical environments’, ‘consistency’ and ‘doing it our way’. Mothers valued their preschooler having good sleep health, however societal factors influenced the degree of autonomy they had over implementing sleep supporting strategies. Integrated mixed methods findings indicate that ethnic and socioeconomic inequities in preschooler sleep health exist in Aotearoa/New Zealand and that social determinants of preschoolers’ sleep include institutional racism, material and financial resources, employment, housing, social support, early childhood education services and child health services. Results indicate that a victim-blaming approach which does not take into account the broader societal context and places blame and burden on mothers not ‘managing’ their child’s sleep ‘properly’ must be rejected. Action is required to address the socio-political drivers that lead to the inequitable distribution of social determinants of preschoolers’ sleep health.
Listed in 2019 Dean's List of Exceptional Theses
The following Figures have been removed for copyright reasons: 1 (= Achermann, 2004, Fig 1); 2 (=Jenni & Le Bourgeois, 2006, Fig 3); 5 (=Grandner, 2017, Fig 1).
Preschool children, Sleep, Social aspects, Economic aspects, Health aspects, New Zealand, Children, Maori, Kōhungahunga, Moe, Hauora, Dean's List of Exceptional Theses