Volume 20, Issue 4 (Winter 2026)                   Salmand: Iranian Journal of Ageing 2026, 20(4): 514-527 | Back to browse issues page

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Sadeghi S, Ghavami V, Amini M, Tehrani H. Predictors of Sleep Quality in Iranian Older Adults Based on the Self-regulation Theory. Salmand: Iranian Journal of Ageing 2026; 20 (4) :514-527
URL: http://salmandj.uswr.ac.ir/article-1-2928-en.html
Predictors of Sleep Quality in Iranian Older Adults Based on the Self-regulation Theory
Sara Sadeghi1 , Vahid Ghavami2 , Mahnaz Amini3 , Hadi Tehrani *4
1- Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
2- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
3- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4- Social Determinant of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. & Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. , tehranih@mums.ac.ir
Keywords: Sleep quality, Aged, Health education, Health promotion
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Introduction
The increase in the number of older adults presents significant challenges, underscoring the need for special consideration of this issue. The mental and physical health of the elderly requires particular attention. Research has shown that the prevalence of insomnia increases with age. Sleep disorders in older adults can lead to a range of serious consequences, including depression, loss of balance and risk of falls, memory disorders, reduced quality of life, cognitive impairment, fatigue, anxiety, and an increased reliance on sleeping pills. Epidemiological studies have indicated that individuals with sleep disorders require more healthcare services, and this issue imposes a significant economic burden on both patients and healthcare systems. Therefore, this study aimed to identify the factors associated with sleep quality and find its predictors among Iranian older adults, based on the social cognitive theory of self-regulation.

Methods & Materials
This is a cross-sectional, descriptive study that was conducted in 2024. The participants were 335 older adults, who were selected using a multi-stage cluster random sampling method from three comprehensive health centers in Neishabur, Iran. The inclusion criteria were age over 60 years, willingness to participate in the study, and the ability to answer the questionnaire. The individuals who failed to complete the questionnaires entirely were excluded. The data collection tools included a demographic form, a researcher-made questionnaire to assess self-regulation scores, and the pittsburgh sleep quality index (PSQI) to measure sleep quality, with higher scores indicating more severe sleep disorders. The questionnaire designed based on the social cognitive theory of self-regulation consisted of 31 items and four dimensions: goal setting (6 items), self-reaction (7 items), self-monitoring (12 items), and judgment of a behavior (6 items). Its content validity index (CVI) was 0.86, and the content validity ratio (CVR) was 0.73. The Cronbach’s alpha coefficient was calculated to be 0.93, and its test, re-test reliability was ICC=0.93. SPSS software version 26 was utilized to analyze the collected data using both descriptive and inferential statistics. For all tests, the significance level was set at 0.05.

Results
The majority of participants were female (51%) and married (73%). Their mean age was 74.00±8.97 years. In terms of education, 70% had less than a high school diploma. Also, 65% had private bedrooms, while 16% did not have bedrooms. The majority did not smoke (73%) and had an underlying disease (82%). 
The results indicated that 70.4% of older adults had poor sleep quality. Their mean self-regulation score was 81.96±17.26, and the mean PSQI score was 8.54±4.65. The total PSQI score for those who took sleeping pills was 12.50±2.82, while for those who did not take sleeping pills, it was 5.51±3.30. This indicates that users of sleeping pills had significantly lower sleep quality (P<0.001). There was no significant difference in sleep quality between smokers and non-smokers (P=0.095). Spearman’s correlation coefficient test revealed a direct and significant correlation between age and total PSQI score (P<0.001). Among the PSQI components, sleep efficiency had the highest score, indicating that the participants had poor sleep efficiency. In contrast, sleep duration had the lowest score, indicating that the participants had better sleep duration.
Based on the results of the univariate linear regression, behavior evaluation and judgment (P<0.001), goal setting (P=0.001), and self-monitoring (P=0.009) were the most effective predictors of sleep quality in older adults. Based on the results of multiple regression, non-use of sleeping pills (β=-10.883, P<0.001), age (β=9.830, P<0.001), no history of underlying disease (β=-5.549, P<0.001), male gender (β=-5.485, P<0.001), behavior evaluation and judgment (β=-3.249, P<0.001), no history of psychological diseases (β=-2.972, P=0.003) and non-smoking (β=-2.931, P=0.004) were predictors of sleep quality (Table 1).


This final regression model explained 78% of the variance in sleep quality. 

Conclusion
The results indicated that poor sleep efficiency was higher among older adults compared to other components of sleep quality. Among the dimensions of self-regulation theory, behavior evaluation and judgment had the highest power in predicting sleep quality, compared to goal-setting and self-monitoring domains. This finding indicates that older adults who are better at evaluating and judging their behavior tend to have better sleep quality. Therefore, it is recommended to design appropriate interventions aimed at empowering older adults to promote their health and improve their sleep quality, focusing on these strategies of self-regulation theory. Among the demographic variables, the non-use of sleeping pills had the highest power in predicting sleep quality of older adults. Based on these results, the use of non-pharmacological methods, such as behavioral interventions, stimulus control, sleep hygiene practices, and cognitive techniques, is recommended to prevent and manage sleep disorders in this group.

Ethical Considerations
Compliance with ethical guidelines
The study protocol was approved by the Ethics Committee of Mashhad University of Medical Sciences (Code: IR.MUMS.REC.1402.100). Participants provided written informed consent after receiving explanations about the study objectives and methods, and were assured of the confidentiality of their information. 

Funding
This article was extracted from the master’s thesis of Sara Sadeghi, funded by Mashhad University of Medical Sciences.

Authors' contributions
Design and conceptualization: Hadi Tehrani, Mahnaz Amini, and Vahid Ghavami; data collection, writing the initial draft: Hadi Tehrani and Sara Sadeghi: data analysis and interpretation: Vahid Ghavami; review & editing: All authors.

Conflicts of interest
The authors declare no competing interests.

Acknowledgments
The authors would like to thank the Vice-Chancellor for Research of Mashhad University of Medical Sciences, the management and staff of comprehensive health centers in Neyshapour, and all participants for their support and cooperation.



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Type of Study: Research | Subject: gerontology
Received: 2024/09/05 | Accepted: 2024/11/04 | Published: 2026/03/01
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