Psychometric analysis of a Chinese version of the Sleep Hygiene Index in nursing students in China: a cross-sectional study.

Tang, Zhengyan; Li, Xiaomei; Zhang, Yongai; Li, Xiaohong; Zhang, Xiaona; Hu, Minhua; Wang, Jing

OBJECTIVE The aim of the study had two stages. One was to examine the psychometric quality of the Sleep Hygiene Index (SHI) in Chinese version and its predicted function for the prevalence of insomnia. The other was to describe the prevalence of poor sleep hygiene habits and associated factors of sleep hygiene habits in Chinese nursing students. METHOD According to Brislin translation model, the English version of SHI was translated into Chinese. And a pilot-survey was carried out to measure psychometric quality of the Chinese version of SHI with 260 nursing students by convenient sampling. Then a cross-sectional survey was conducted. 659 undergraduates were recruited by simple random sampling in a medical university in China. Data collection instruments consisted of a demographic questionnaire, the Sleep Hygiene Index (SHI), the Insomnia Severity Index (ISI) and the Brief Insomnia Questionnaire (BIQ). Data were analyzed by SPSS 24.0 and Amos 24.0 with P = 0.05 as the significant test value. RESULTS The internal consistency reliability of SHI in Chinese version was more than 0.60 (α = 0.62, ω = 0.63). The concurrent validity presented significantly (r = 0.25, P < 0.001). Exploratory factor analysis found that a six component model explained 63.06% of total variance and confirmatory factor analysis showed good fitness (χ2/df=2.14, RMSEA = 0.04). ROC analysis showed that the cut-off value predicting for insomnia was 5.50 (52.90% sensitivity and 75.80% specificity). The area under the ROC curve was 0.66 (95% confidence interval = 0.61-0.71). 199 (30.20%) participant had poor sleep hygiene habits, especially in the aspects of staying too longer in bed (65.25%) and irregular sleep schedule. Multiple linear regression analysis showed health condition, academic difficulties and gender were more common associated factors of sleep hygiene. CONCLUSIONS The Chinese version of the Sleep Hygiene Index demonstrates satisfactory psychometric qualities and has higher sensitivity and specificity to predict for insomnia. So SHI could be used in Chinese nursing students and detect high levels of insomnia. The status of sleep hygiene of nursing students in China should be concerned. Sleep hygiene education should be carried out in nursing students with different gender, health condition, and academic performance.