Developing a systems-based programme theory for reducing night-time interactive electronic device use and improving sleep among adolescents.

BACKGROUND

Adolescent night-time use of interactive electronic devices (IEDs) is increasingly linked to poor sleep, mental health challenges, and reduced academic performance. However, existing interventions often overlook the complex systems shaping these behaviours. This study presents a first-of-its-kind systems-based programme theory for CLOCK OFF - a peer influence intervention aimed at reducing night-time IED use and improving adolescent sleep - created through novel participatory mapping activities and analyses, which involved adolescents, parents and teachers.

METHODS

We conducted five online participatory workshops with adolescents (aged 11-14 years), parents, and teachers across four United Kingdom schools, supported by desk-based research. Workshop activities were facilitated using StickyStudio software. Causal loop diagramming was used to identify system components and feedback loops influencing adolescent IED use and sleep. Causal loop diagrams (CLDs) were iteratively built using Kumu software, refined and validated through stakeholder input and network analysis. The final CLD informed the development of a systems-based programme theory.

RESULTS

Thirty participants (23 adolescents, 7 adults) contributed to the systems mapping process. The final CLD comprised 68 factors (i.e., causal influences of night-time IED use) and 131 connections between these factors, spanning behavioural, educational, psychological, physiological, social, and technological domains. CLOCK OFF-related mechanisms were represented across a large proportion of the system's identified feedback structures. The programme theory diagram included 72 factors and 147 feedback loops, grouped into five subsystems. These subsystems highlighted the dynamic interplay between enjoyment, overstimulation, fear of missing out (FOMO), emotional regulation, and educational stress.

CONCLUSIONS

Participatory systems mapping with adolescents is a feasible and valuable method for surfacing complex behavioural drivers and informing intervention design. CLOCK OFF's systems-based programme theory offers a novel approach for understanding and addressing adolescent night-time IED use and sleep disruption. Findings support the need for multi-actor and peer-led, multi-level interventions embedded within broader systemic strategies.