Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Mar 19, 2023; 13(3): 113-125
Published online Mar 19, 2023. doi: 10.5498/wjp.v13.i3.113
Hospital-acquired insomnia scale: A validity and reliability study
Bahar Çiftçi, Güzel Nur Yıldız, Özgür Yıldız
Bahar Çiftçi, Department of Fundamental of Nursing, Atateknokent Atatürk University, Erzurum 25000, Turkey
Güzel Nur Yıldız, Department of Dialysis, Muş Alparaslan University, Muş 49000, Turkey
Özgür Yıldız, Department of Nursing, Muş Alparslan University, Muş 49000, Turkey
Author contributions: Çiftçi B contributed to the data collection; Yıldız GN contributed to the data analysis; Çiftçi B,Yıldız GN and Yıldız Ö wrote the manuscript and critically revised the important intellectual content; All authors contributed to the study design and study supervision.
Institutional review board statement: This work was approved by the Muş Alparslan University Scientific Research and Publication Ethics Committee, No. 16/08/2021-20028.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
STROBE statement: The manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bahar Çiftçi, PhD, Assistant Professor, Department of Fundamental of Nursing, Atateknokent Atatürk University, Erzurum/Yakutiye, Erzurum 25000, Turkey. bahar.ciftci@atauni.edu.tr
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: January 31, 2023
Revised: February 4, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: March 19, 2023

Sleep breathing, one of the basic human needs, is a physiological need that affects cardiac functions, body temperature, daily vitality, muscle tone, hormone secretion, blood pressure, and many more. In the international literature, studies reported that patients have had sleep problems in the hospital since the 1990s, but no measurement tool has been developed to determine the causes of hospital-acquired insomnia in individuals. These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing. Although patients generally experience hospital-acquired sleep problems, there is no measurement tool to determine hospital-acquired sleep problems. These features show the originality of the research.


To develop a measurement tool to determine the sleep problems experienced by patients in the hospital.


A personal information form, hospital-acquired insomnia scale (HAIS), and insomnia severity index (ISI) were used to collect research data. The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022. The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage. Exploratory factor analysis and confirmatory factor analysis (CFA) analyses were performed using the SPSS 20 package program and the analysis of moment structure (AMOS) package program. Equivalent forms method used.


The HAIS consisted of 18 items and 5 subscales. The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783. The scale explained 58.269% of the total variance. The items that constitute the factors were examined in terms of content integrity and named as physical environmental, psychological, safety, socioeconomic, and nutritional factors. CFA analysis of the 5-factor structure was performed in the AMOS package program. The fit indices of the obtained structure were examined. It was determined that the values obtained from the fit indices were sufficient. A significant correlation was determined between the HAIS and the ISI, which was used for the equivalent form method.


The HAIS is a valid and reliable measurement tool for determining patients’ level of hospital-acquired insomnia. It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.

Keywords: Insomnia, Sleeplessness, Sleep disorder, Scale development, Hospital, Hospital housekeeping

Core Tip: Sleep, which is one of the basic human needs, is a physiological need that affects heart functions, hormone secretion, mood, psychological state and many more. Although there are studies in the international literature reporting that patients have sleep problems in the hospital since the 1990s, a measurement tool has not been developed to determine the causes of hospital-acquired insomnia in individuals. Determination of hospital-acquired insomnia causes of individuals; It will provide many benefits such as increasing the quality of care, improving mood, reducing stress levels, increasing the effectiveness of treatment, and increasing psychological resilience. In this research, a measurement tool was developed to identify the causes of hospital-acquired insomnia and to identify the causes of insomnia in hospitals or inpatient health institutions by focusing on the vital sleep activity. A measurement tool consisting of 18 items and 5 factors was developed. In addition, the literature on the factors that cause hospital-acquired insomnia was reviewed and some recommendations were made.