Developing a Pragmatic Online Behavioural Intervention for Shift Work Disorder in NHS Staff

Forrest Tin Wai Cheung, Rachel Sharman, Dimitri Gavriloff, Thavapriya Sugavanam, Leah Holmes, Anne Keane, Colin A. Espie, Amy C. Reynolds, David Ray, Simon D. Kyle

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Abstract

Introduction: Shift work disorder (SWD), characterised by complaints of insomnia and excessive daytime sleepiness attributed to shift work, affects around 27% of workers. SWD is often associated with poorer physical and mental health. Cognitive behavioural therapy for insomnia (CBT-I) has shown suboptimal results in achieving clinically significant changes in insomnia symptoms among shift workers. This suggested that a more tailored behavioural approach, addressing the insomnia symptoms and daytime sleepiness associated with SWD, may be beneficial. This study outlines the development process of a novel, online, and pragmatic behavioural intervention for shift workers employed by the National Health Service (NHS) in England.

Materials and methods: The Oxford Behavioural Intervention for Shift workers (OxBIS) has been co-developed by researchers and individuals with lived experience of shift work. A four-member core intervention development team, consisting of sleep and circadian scientists and a clinical psychologist, reviewed existing literature and drew upon clinical experiences from working with shift workers to inform the development process. Patient and public involvement have been integral throughout the development, with 10 diverse individuals with lived experience forming the NHS Nightshift Workers Research Advisory Group (RAG). The RAG held regular meetings to provide advice on intervention development, specifically regarding content and delivery. Additionally, the RAG was responsible for testing content materials and providing feedback and suggestions.

Results: Seven meetings were held with the RAG members, shaping the three iterations of the intervention. Their firsthand experience as NHS shift workers provided valuable insights into the realities of shift work culture. The resulting OxBIS programme consists of six one-to-one sessions lasting 1-1.5 hours, to be delivered online by trained facilitators. Key intervention targets include enhancing sleep and circadian knowledge, optimising the sleep-wake schedule, scheduled light exposure and blockade, adjusting lifestyle factors, implementing stimulus control, and managing maladaptive sleep-related thoughts using cognitive strategies. Their feedback was crucial in the intervention development. The RAG members supported content refinement, ensured appropriate terminology throughout the materials, contributed to the creation of a shift worker-specific sleep diary, prioritised suitable outcome measures, and advised on practical and logistical considerations, such as recruitment strategies.

Conclusions: The OxBIS intervention reflects a comprehensive and tailored approach for addressing behavioural, circadian, and lifestyle factors that perpetuate SWD. Co-development with individuals who have lived experience ensures that the intervention is patient-centred and focused on the specific needs of shift workers in the NHS. A feasibility and acceptability trial for the OxBIS intervention is currently underway (Ref: PID 18679). The trial aimed to provide empirical evidence on its suitability and inform future implementation.

Acknowledgments: Our thanks go to RAG members for their expert input and insights. This work was supported by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research awarded to DR (Ref: NIHR203667). RS and SDK are supported by the NIHR Oxford Health Biomedical Research Centre grant (Ref: NIHR203316).

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Recommended citation: Cheung, F. T. W., Sharman, R., Gavriloff, D., Sugavanam, T., Holmes, L., Keane, A., Espie, C. A., Reynolds, A. C., Ray, D., & Kyle, S. D. (2026). Developing a Pragmatic Online Behavioural Intervention for Shift Work Disorder in NHS Staff. Sleep Medicine, 138, 107123. https://doi.org/10.1016/j.sleep.2025.107123