Co-designed Sleep Health Program Improves Sleep Health of Australian First Nations Adolescents: Findings from a Pilot Study
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Background
Adolescent sleep health is a growing public health concern, yet no culturally responsive sleep health program has been developed for Aboriginal and Torres Strait Islander (First Nations) young people. This study reports the outcomes and acceptability of Australia’s first co-designed sleep health program for First Nations adolescents.
Methods
The Let’s Yarn About Sleep adolescent program was co-designed with First Nations community members from 23 Traditional groups, involving 174 Elders, adolescents, parents, carers, and service providers. The program drew on an Aboriginal pedagogical framework and the COM-B behaviour change model, integrating Western and First Nations sleep science, and was delivered by Aboriginal Youth Workers trained as Sleep Coaches. Outcomes included self-reported improvements in sleep knowledge, sleep timing and continuity, sleep quality, overall sleep health, and psychological distress. Post-program changes in outcomes were assessed using linear mixed-effects regression analyses. Program ratings and yarning-based feedback assessed acceptability.
Findings
70 First Nations young people participated in the program (median age 13.0 years, range 12–18; 67.1% female). Sleep knowledge improved substantially, with the mean composite score increasing from −0.65 (SD 1.23) at baseline to 0.82 (SD 1.27) at follow-up, a large effect (Cohen’s d = 1.18; p < 0.001). A significant improvement was observed in the overall sleep health score, representing a medium effect (Cohen’s d = 0.63; β = 0.68, 95% CI: 0.31–1.04; p < 0.001). Psychological distress showed a directional reduction that did not reach statistical significance (Cohen’s d = 0.32; β = −0.49, 95% CI: −1.08–0.09; p = 0.097), though a modest beneficial effect cannot be excluded. High acceptability was reflected in program ratings and qualitative feedback, with participants reporting greater sleep awareness, improved sleep behaviours, and strong community engagement with the program.
Interpretation
A culturally grounded, co-designed sleep health program can improve sleep knowledge and overall sleep health and achieve high acceptability among First Nations adolescents. Community leadership, local delivery, and the embedding of First Nations worldviews are likely central to achieving impact, highlighting a promising pathway to address sleep health inequities
Funding
Medical Research Future Fund (APP1201569). No competing interests.
Research in context
Evidence before this study
We searched PubMed, Scopus, and PsycINFO for peer-reviewed studies published between January 2010 and Sep 2025 with language restrictions, using the search terms: “adolescent sleep health” , “sleep education” , “Indigenous” , “First Nations” , “co-design” , and “community-led delivery” . Reference lists of relevant reviews were also screened. Evidence from systematic reviews and meta-analyses showed that most adolescent sleep interventions are delivered in school or community settings and are grounded in behavioural or cognitive–behavioural approaches. The existing sleep health programs are mainly delivered by sleep health researchers or healthcare providers in school settings over short durations (four to six weeks) and have produced modest short-term improvements in some aspects of sleep health. None of these programs was co-designed or culturally adapted for First Nations communities or offered in community settings. Further, most tools used to assess sleep health and knowledge were developed in Western contexts, with little consideration of First Nations’ conceptualisation of sleep health or of cultural and contextual factors that impact it. No prior studies have integrated First Nations governance and culturally grounded learning frameworks to improve the sleep health of First Nations adolescents.
Added value of this study
This is Australia’s first sleep health program for First Nations adolescents. This co-designed program combined Western and First Nations sleep science and privileged First Nations cultural knowledge and practices to address the sleep health needs of First Nations adolescents holistically. This community-based program demonstrated significant improvements in sleep knowledge and sleep health, with strong community engagement and satisfaction.
Implications of all the available evidence
Co-designed and community-led approaches can help improve the sleep health of First Nations young people. Embedding First Nations leadership, local workforce development, and community governance structures into sleep health programs could improve program engagement and acceptability and potentially lead to improvements in sleep health. Future research should focus on integrating culturally responsive sleep health programs within school and community well-being systems to reduce sleep health inequities and improve life outcomes for First Nations adolescents.
