|Year : 2018 | Volume
| Issue : 3 | Page : 195-200
The Association between sleep quality and well-being amongst allied health sciences students in a public university in Malaysia
Nurul Hazirah Mohd Zaid1, Nor Azlina A Rahman1, Mainul Haque2
1 Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, 25200 Kuantan, Malaysia
2 Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), 57000 Kuala Lumpur, Malaysia
|Date of Web Publication||24-Sep-2018|
Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
Source of Support: None, Conflict of Interest: None
Background: According to researches, low sleep quality may lower the well-being of the students directly. One of the known components of well-being is satisfaction with life. Hence, this study is done to address if there is any relationship between sleep quality and well-being by measuring the quality of sleep and satisfaction with life. Purpose: This study was done to identify the association between quality of sleep and well-being amongst Allied Health Sciences students in a public university in Malaysia. Aside from that, it was also completed to compare the sleep quality and well-being between the different study programs, years of study and genders of the students. Materials and Methods: The study design chosen for this study was a cross-sectional study. A total of 120 students from the years 1, 2, 3 and 4 of the six study programs in the Allied Health Sciences faculty were selected by convenience sampling. The students were required to answer one set of questionnaires consisting of the consent form, information sheet, sociodemographic data, Pittsburgh Sleep Quality Index (PSQI) and Satisfaction with Life Scale (SWLS). The questionnaire was analysed by incorporating Kruskal–Wallis test, ANOVA, independent t-test and Pearson correlation test. Results: This research found that there was no significant difference of PSQI and SWLS scores between different study programs (P = 0.250 and P = 0.106, respectively), years of study (P = 0.162 and P = 0.704, respectively) and genders (P = 0.070 and P = 0.201, respectively) in the faculty. The results, however, indicated that there was a significant fair negative correlation between PSQI and SWLS amongst the students (P < 0.001; r = −0.416). Conclusion: This study amongst Allied Health Sciences students can be safely concluded that there was no difference in sleep quality and satisfaction with life between audiology, dietetic, biomedical science, physiotherapy, optometry and radiography students, neither between the years 1, 2, 3 and 4 nor between male and female students. On the other hand, better sleep quality was significantly associated with better satisfaction of life, hence the well-being of the students.
Keywords: Allied Health Sciences, satisfaction with life, sleep quality, students, well-being
|How to cite this article:|
Mohd Zaid NH, A Rahman NA, Haque M. The Association between sleep quality and well-being amongst allied health sciences students in a public university in Malaysia. Adv Hum Biol 2018;8:195-200
|How to cite this URL:|
Mohd Zaid NH, A Rahman NA, Haque M. The Association between sleep quality and well-being amongst allied health sciences students in a public university in Malaysia. Adv Hum Biol [serial online] 2018 [cited 2020 Jan 24];8:195-200. Available from: http://www.aihbonline.com/text.asp?2018/8/3/195/241925
| Introduction|| |
Poor sleep is strongly associated with higher levels of depression. Depression is a serious mental illness that leads the sufferer to have much lesser joy in life, thus making the person no longer interested in living well. This issue by no doubt will lower the life quality and well-being of an individual. The subjective well-being is often measured with the satisfaction with life. Quality of sleep was suggested to play an important role in determining the satisfaction with life of a person. Poor sleep quality amongst students, including Allied Health Sciences students, may cause difficulty in learning and thus may affect their future in becoming health professionals in their later lives. Hence, a research to recognise the sleep quality amongst Allied Health students is crucial to ensure excellence in their academic achievement and future. Hence, this research aimed to identify the association between sleep quality and the well-being amongst students of an Allied Health Sciences faculty in a public university in Malaysia. This study was also intended to explore if sleep quality and well-being of the students differ across sociodemographic data aside from determining the existence of association between sleep quality and well-being amongst the students.
Compassion is a sign of well-being. Those who are happy and satisfied with life are deemed to be more compassionate about others. A study revealed that undergraduate healthcare students were more passionate compared to qualified health professionals in term of treating patients. Hence, it is important to study the level of well-being of Allied Health Sciences students so that appropriate measures can be taken whether to preserve or improve the compassion instilled in the future healthcare providers to ensure better healthcare quality. Sleep is typically accompanied by postural recumbence, behavioural quiescence and closed eyes. Sleep quality and pattern of sleep-wakefulness are adapted to individual, social and environmental demands. It promotes physical and mental well-being. Good sleep quality usually represented by satisfaction, appropriate timing, adequate duration, high efficiency and sustained alertness during waking hours. Life satisfaction refers to a judgmental process in which individuals assess the quality of their lives based on their own unique set of criteria., Furthermore, well-being is a complex construct that concerns optimal experience and functioning. It is usually represented by satisfaction with life.
| Materials and Methods|| |
The study participants were undergraduate students of an Allied Health Sciences faculty in a public university in Malaysia from the years 1, 2, 3 and 4 from different undergraduate study programs, namely, audiology, biomedical science, optometry, dietetic, physiotherapy and radiography. Convenience sampling was used to recruit the participants. The minimal sample size needed in the study was 89, based on a calculation by Raosoft sample size calculator, incorporating 10% margin of error, 95% confidence level, approximately 800 population and 50% response distribution. The participants fulfilled the inclusion and exclusion criteria such as being an undergraduate student of the Allied Health Sciences faculty and were not diagnosed with any medical illness related to sleep and depression (e.g., insomnia and depression).
The data collection was done from May to June 2017. This study used self-administered questionnaire to collect the data which consisted of two parts. The first part was to gather the sociodemographic data of the participants which consisted of the study programs of the participants, their year of study, age, gender and race. Then, the second part consisted of Pittsburgh Sleep Quality Index (PSQI) and Satisfaction with Life Scale (SWLS). PSQI includes seven subscales (subjective sleep satisfaction, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medication and daytime dysfunction) that were combined into a global score ranging from 0 to 21. PSQI is a useful, valid and reliable tool for the assessment of sleep quality, with an overall efficiency comparable to the other language version, and differentiates 'good' from 'bad' sleepers. The PSQI is widely accepted because of its established psychometrics amongst various populations. Another recent study mentioned that the PSQI showed an overall reliability coefficient with Cronbach's alpha of 0.835, indicating a high degree of internal consistency. SWLS is a questionnaire used to assess individuals' evaluation of their life in general. Five items (e.g., 'I am satisfied with my life') were rated on a seven-point scale (1 = strongly disagree to 7 = strongly agree) and combined so that higher scores indicate higher well-being. SWLS  was developed as a measure of the judgmental component of subjective well-being. SWLS has adequate internal consistency (α = 0.79)., SWLS possesses a good reliability with r = 0.83. SWLS good concurrent validity was also assessed for Malaysian context.
The data were analysed using the Statistical Package for the Social Science (SPSS) version 21 (IBM Corp., Armonk, New York, USA). Descriptive statistics was used to explore the distribution of the PSQI and SWLS global scores of the participants. Kruskal–Wallis test, one-way ANOVA and independent t-test were used to find if there was any significant difference of sleep quality and well-being according to PSQI and SWLS scores between the six study programs, years of study and genders of the participants, respectively. In addition, Pearson correlation test was done to investigate the relationship between PSQI and SWLS scores of the participants.
This study obtained the ethical approval from the International Islamic University Malaysia Research Ethics Committee (Memo No.: IIUM/504/14/11/12/IREC 886, Dated July 3, 2017), where the voluntarism and confidentiality of each participant were ensured throughout the study. The research methodology is illustrated in the flowchart in [Figure 1].
| Results|| |
Global scores of Pittsburgh Sleep Quality Index
Global PSQI is the total scores of the seven subscales in the questionnaire [Figure 2]. The recommended cut-off score is 5. Scores higher than 5 mean poor sleep quality and scores lower than 5 indicate good sleep quality. The X-axis of the chart is the global PSQI score while the Y-axis is the number of participants. [Figure 2] shows that two participants scored 0, which is the lowest and best sleep quality. One participant got the highest score of 16, which is 11 scores higher than 5, which is the cut-off score. The score that has the highest frequency was 5, which is the cut-off score, indicating 20 (16.7%) participants having adequate sleep quality. The results also indicated that only 22 (18.3%) participants had global PSQI scores of <5 indicating good sleep quality while the majority of them (65%) had scores of >5 indicating poor sleep quality.
|Figure 2: Global Pittsburgh Sleep Quality Index of the participants (n = 120).|
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Global Satisfaction with Life Scale Score
Global SWLS score is the sum of the five subscales in the questionnaire [Figure 3]. The score can range from 5 to 35. The scores of 5–9 mean extremely dissatisfied with their life, 10–14 is dissatisfied, 20 means neutral, 21–25 means slightly satisfied with life, 26–30 means satisfied with their life and 31–35 means extremely satisfied. The lower the scale, the less life satisfaction recorded amongst the participants. [Figure 2] shows that three participants got the highest scores of 35, two participants got the scores of 34 and another three got the scores of 31, which means they were extremely satisfied with their lives. On the other hand, only one participant was extremely dissatisfied with his/her life with the score of 8. [Figure 3] also shows that most of the participants were satisfied with their lives (scores of 21–35) with the frequency of 79 (65.8%) compared to only 23 (19.2%) participants who were dissatisfied with their life (scores of 5–19).
|Figure 3: Global Satisfaction with Life Scale score of the participants (n = 120).|
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Difference of Pittsburgh Sleep Quality Index and Satisfaction with Life Scale scores across study programs
Kruskal–Wallis test was used to investigate whether the scores of SWLS and PSQI differ significantly according to the six different study programs with 20 students in each program [Table 1].
|Table 1: Comparing Pittsburgh Sleep Quality Index and Satisfaction with Life Scale scores between different study programs (Kruskal-Wallis test, n=120)|
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The Kruskal–Wallis test done for PSQI gave P = 0.250, and hence, it can be concluded that the sleep quality between different study programs was not significantly different from each other. The P value for SWLS is 0.106 which also concluded that the well-being of each study program did not differ significantly from each other.
Difference of Pittsburgh Sleep Quality Index and Satisfaction with Life Scale score across years of study
One-way ANOVA was used to investigate whether the values of SWLS and PSQI scores differ significantly according to the years of study 1, 2, 3 and 4 [Table 2]. From the test done for PSQI, P = 0.162 which is higher than 0.05. Hence, it can be concluded that the sleep quality between the different years of study is not significantly different. The P value for SWLS is 0.704 which indicates that the well-being of the students from the different years of study is similar.
|Table 2: Comparing Pittsburgh Sleep Quality Index and Satisfaction with Life Scale scores between different years of study (ANOVA, n=120)|
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Difference of Pittsburgh Sleep Quality Index and Satisfaction with Life Scale score across gender
Independent t-test was used to investigate whether the values of SWLS and PSQI scores differ significantly according to the genders of male and female [Table 3]. From the independent t-test done for PSQI, P = 0.070 which is higher than 0.05. Hence, it can be concluded that the sleep quality is not significantly different between male and female students. P = 0.201 for SWLS indicates that the well-being of male or female students did not differ significantly from each other.
|Table 3: Comparing Pittsburgh Sleep Quality Index and Satisfaction with Life Scale scores between genders (Independent t-test, n=120)|
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Association between sleep quality and well-being
This study also tried to assess the association between sleep quality and well-being through PSQI and SWLS scores, respectively, amongst Allied Health Sciences students [Figure 4]. The ellipse formed is pointing downward, with the P value of Pearson correlation test of <0.001; hence, a negative significant correlation between PSQI and SWLS scores is concluded.
|Figure 4: Association between Pittsburgh Sleep Quality Index and Satisfaction with Life Scale (n = 120).|
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r = −0.416 from the Pearson correlation test done between PSQI and SWLS scores concluded a negative fair correlation between the two variables. Negatively correlated means that SWLS score is inversely proportional to the PSQI score. The lower the PSQI score, the higher the SWLS score will be. Lower PSQI score reflects better sleep quality while higher SWLS score means better satisfaction with life which represents well-being. This indicates that better sleep quality (lower PSQI scores) is associated with better satisfaction in life (higher SWLS scores).
| Discussion|| |
Difference of sleep quality and well-being across departments
According to the mean score, generally, the students from the different study programs had poor sleep quality. Besides, the students from audiology, biomedical science, dietetic, optometry and radiography were only slightly satisfied with their lives, except for physiotherapy students who were satisfied with their lives. However, this study reported no significant difference of sleep quality and well-being amongst students from the different Allied Health Sciences study programs. This finding contradicts with a previous study which found a significant different level of sleep quality and well-being amongst students of different courses.
In the previous study, the sleep quality and well-being amongst their students of different departments may differ due to the difference in academic syllabus, academic workload and total credit hours of each program. The students with higher workloads and total credit hours may have poorer sleep and this will cause the reduction in their well-being.
Difference of sleep quality and well-being across years of study
This study found no significant difference of sleep quality and well-being amongst students of different years of study. However, the year of study with highest PSQI scores was year 2 and the lowest was year 4 which showed that the students in year 2 had the poorest sleep quality while the students in year 4 possessed the best sleep quality amongst all Allied Health Sciences students in the study. This contradicts with an earlier study which found that the final-year students had poorer sleep quality compared to the first-year students due to clinical workload. Besides, in the current study, the students in year 2 had the lowest well-being compared to students in other years. The students in year 4 had the highest well-being compared to other students in the study. These findings were again not parallel with a previous study which revealed that quality of sleep and satisfaction with life decreases with age. The students in the Allied Health Sciences faculty in this study usually went for clinical practice in the years 3 and 4 of their study.
On comparing the sleep quality and well-being of the students from different years of study, no significant difference was found. This may be since all participants acquired had already finished their clinical practice and just stayed in the university campus. Nevertheless, the mean PSQI and SWLS scores for each year of study did differ though not significant statistically.
Difference of sleep quality and well-being across gender
This study found no significant difference of sleep quality and well-being amongst students of different genders. The result disputed with the previous study which found a significant difference in sleep quality and well-being amongst students across genders. Nonetheless, the mean PSQI and SWLS scores of female and male students did differ though not significant statistically. Female students possessed lower quality of sleep and lower well-being with mean PSQI and SWLS of 7.01 and 22.50, respectively. The PSQI and SWLS scores for male students were 6.80 and 24.13, respectively. This indicates that male students had slightly better sleep quality and well-being compared to female students. The finding was in line with an earlier study which found that female students had poorer sleep compared to male students. This may be due to hormonal changes in females affecting the sleep cycle and causing more awakenings in the middle of the night.
Association between sleep quality and well-being
This study found a fair correlation between sleep quality and well-being among the participants. P < 0.001 and r = −0.416 from Pearson correlation test done to investigate the existence of homogeneity between PSQI and WSLS amongst Allied Health Sciences students in this study indicate that the two scores have fair negative correlation between each other, meaning that better sleep quality was associated with better well-being. The occurrence of connection between sleep quality and well-being using PSQI and SWLS scores, respectively, in this study was like multiple previous studies., Lack of sleep will affect the optimism-sociability, tiredness-fatigue, anger-aggression and bodily discomfort significantly.
| Conclusion|| |
There was no difference in sleep quality and satisfaction with life between audiology, dietetic, biomedical science, physiotherapy, optometry and radiography students, neither between the years 1, 2, 3 and 4 nor between male and female students amongst the Allied Health Sciences students. However, it was found that better sleep quality was significantly associated with better satisfaction of life, hence the well-being of the students.
Limitation of the study and recommendations
This was a cross-sectional study and therefore a conclusion of causal-effect relationship between variables cannot be made, while the generalization of results to study population is not possible because of the convenience sampling used in recruiting the study participants. Hence, it is recommended that further study using cohort study and/or random sampling should be carried out to get more conclusive results.
The authors are much grateful to all those students who participated in the current study in their very tight teaching–learning program.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sivertsen B, Harvey AG, Lundervold AJ, Hysing M. Sleep problems and depression in adolescence: Results from a large population-based study of Norwegian adolescents aged 16-18 years. Eur Child Adolesc Psychiatry 2014;23:681-9.
Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess 1985;49:71-5.
Bray L, O'Brien MR, Kirton J, Zubairu K, Christiansen A. The role of professional education in developing compassionate practitioners: A mixed methods study exploring the perceptions Xof health professionals and pre-registration students. Nurse Educ Today 2014;34:480-6.
Buysse DJ. Sleep health: Can we define it? Does it matter? Sleep 2014;37:9-17.
Shin DC, Johnson DM. Avowed happiness as an overall assessment of the quality of life. Soc Indic Res 1978;5:475-92.
Ryan RM, Deci EL. On happiness and human potentials: A review of research on hedonic and Eudaimonic well-being. Annu Rev Psychol 2001;52:141-66.
Diener E. Subjective well-being. The science of happiness and a proposal for a national index. Am Psychol 2000;55:34-43.
Buysse DJ, Reynolds CF 3rd
, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
Smyth CA. Evaluating sleep quality in older adults: The Pittsburgh sleep quality index can be used to detect sleep disturbances or deficits. Am J Nurs 2008;108:42-50.
Otte JL, Rand KL, Carpenter JS, Russell KM, Champion VL. Factor analysis of the Pittsburgh sleep quality index in breast cancer survivors. J Pain Symptom Manage 2013;45:620-7.
Lusic Kalcina L, Valic M, Pecotic R, Pavlinac Dodig I, Dogas Z. Good and poor sleepers among OSA patients: Sleep quality and overnight polysomnography findings. Neurol Sci 2017;38:1299-306.
Pavot W, Diener E, Colvin CR, Sandvik E. Further validation of the satisfaction with life scale: Evidence for the cross-method convergence of well-being measures. J Pers Assess 1991;57:149-61.
Lemola S, Ledermann T, Friedman EM. Variability of sleep duration is related to subjective sleep quality and subjective well-being: An actigraphy study. PLoS One 2013;8:e71292.
Aishvarya S, Maniam T, Karuthan C, Sidi H, Nik Jaafar NR, Oei TP, et al.
Psychometric properties and validation of the satisfaction with life scale in psychiatric and medical outpatients in Malaysia. Compr Psychiatry 2014;55 Suppl 1:S101-6.
Caldwell K, Emery L, Harrison M, Greeson J. Changes in mindfulness, well-being, and sleep quality in college students through Taijiquan courses: A cohort control study. J Altern Complement Med 2011;17:931-8.
Howell AJ, Jahrig JC, Powell RA. Sleep quality, sleep propensity and academic performance. Percept Mot Skills 2004;99:525-35.
Tsai LL, Li SP. Sleep patterns in college students: Gender and grade differences. J Psychosom Res 2004;56:231-7.
Baldwin CM, Griffith KA, Nieto FJ, O'Connor GT, Walsleben JA, Redline S, et al.
The association of sleep-disordered breathing and sleep symptoms with quality of life in the sleep heart health study. Sleep 2001;24:96-105.
Pilcher JJ, Ginter DR, Sadowsky B. Sleep quality versus sleep quantity: Relationships between sleep and measures of health, well-being and sleepiness in college students. J Psychosom Res 1997;42:583-96.
Pilcher JJ, Ott ES. The relationships between sleep and measures of health and well-being in college students: A repeated measures approach. Behav Med 1998;23:170-8.
Haack M, Mullington JM. Sustained sleep restriction reduces emotional and physical well-being. Pain 2005;119:56-64.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]