Abstract
OBJECTIVES: To test the effectiveness of a mobile phone text message-based intervention to mitigate fatigue and improve indicators of sleep health in a nationally representative sample of emergency medical services clinician shift workers. METHODS: We conducted a cluster-randomized trial of emergency medical services agencies in the United States. Agencies (clusters) were randomized to intervention or the attention control group. Individual emergency medical services clinician shift workers used a mobile app to complete monthly surveys for 6 months and answered text message queries 1 out of every 4 weeks. Intervention text messages promoted adoption of fatigue mitigation behaviors. All attention control group text messages focused on teamwork improvement. RESULTS: In total, 108 emergency medical services agencies and 708 emergency medical services shift workers were enrolled. Participants responded to >77% of monthly surveys and text message queries. The proportion of emergency medical services shift workers reporting severe fatigue declined over the study period; however, differences by intervention and attention control group status were not statistically significant. The proportion of participants with a clinically meaningful reduction in daytime sleepiness at 6 months was greater in the intervention group vs. the attention control group (p = .04). CONCLUSIONS: Mobile phone text message-based assessments followed by immediate intervention are engaging, scalable on a nationwide level, and effective for addressing some indicators of sleep health like daytime sleepiness. Interventions combining behavioral sleep recommendations with fatigue mitigation strategies could result in larger effects on sleep health and fatigue. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID# NCT04456764 registered on June 29, 2020. First enrollment/consent on December 8, 2020.