Storybook App vs Cognitive Behavioral Therapy for Child Sleep and Attachment

Sleep regulation and the parent‐child relationship are important components of earlychildhood development. Pediatric sleep problems may affect child behavior, familyroutines, and caregiver well‐being. However, access to specialized face‐to‐facepsychological care may be limited in some settings. Mobile health interventions may offeran accessible way to support caregivers at home, but they require evaluation againstevidence‐based approaches.This study was a completed, two‐arm, parallel‐group randomized controlled trial withbaseline and postintervention assessments. The trial evaluated a caregiver‐mediatedmobile health intervention delivered through the Storybook mobile application comparedwith a cognitive behavioral therapy‐based psychoeducational intervention. The study wasconducted in Azuay Province, Ecuador.Participants were children aged 12 to 84 months whose legal guardians provided writteninformed consent. Seventy‐one children were assessed at baseline. Of these, 60 childrenwere randomized and assigned to one of two intervention groups: 31 to the Storybookmobile application group and 29 to the CBT‐based psychoeducation group. All randomizedparticipants completed the intervention and postintervention assessment procedures andwere included in the final analytic sample.The Storybook intervention consisted of caregiver‐led use of the mobile application athome for 40 minutes per day over 1 month. Caregivers received instructions on how to usethe application with the child. The application included guided massage, auditorynarration, and music, with the aim of supporting a calm bedtime routine andcaregiver‐child interaction.The active comparator consisted of eight face‐to‐face psychoeducational sessions based oncognitive behavioral therapy principles. Each session lasted approximately 40 minutes,and sessions were delivered twice weekly over 1 month. The sessions were directed tolegal guardians and focused on behavioral strategies for child sleep, including sleephygiene, consistent bedtime routines, positive reinforcement, and management ofdisruptive pre‐sleep behaviors.The main areas of assessment were child sleep quantity, child sleep quality, andparent‐child attachment. Assessments were conducted at baseline and after completion ofthe 1‐month intervention period. Sleep outcomes were assessed using the Brief InfantSleep Questionnaire and the BEARS Sleep Screening Tool. Parent‐child attachment wasassessed using the Attachment Q‐Set. Statistical analyses compared baseline andpostintervention values within each group and postintervention outcomes between groups,using parametric or nonparametric procedures according to the distribution andmeasurement level of each variable.