Co-designed Sleep Health Program Improves Sleep Health of Australian First Nations Adolescents: Findings from a Pilot Study

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 - 8; 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; {beta} = 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; {beta} =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