Effect of Health Promotion Model-Based Oculomotor Exercise Program on Sleep Quality in Older Adults

This randomized controlled trial aims to evaluate the effect of a Health Promotion Model-based oculomotor exercise program on sleep quality among older adults living in a nursing home. Participants in the experimental group will receive an approximately 3-month structured intervention integrating oculomotor exercises and motivational interviewing techniques, while the control group will receive no intervention and continue with their usual daily routines.

The intervention is designed according to the components of the Health Promotion Model, targeting self-efficacy and behavior change processes. During the first meeting, participants complete baseline assessments, including the Personal Information Form, Sleep Beliefs Scale, Stages of Change Inventory, DSM-5 Sleep Disorder Scale, and Pittsburgh Sleep Quality Index (PSQI). Over four weeks, participants in the experimental group perform oculomotor exercises three times a week (Monday, Wednesday, Friday) and attend weekly motivational interviewing sessions focusing on awareness, perceived benefits, self-efficacy, decision balance, empowerment, and commitment to behavior. Weekly DSM-5 Sleep Disorder assessments are also conducted.

Follow-up sessions continue during the second and third months to support maintenance of behavior change, with monthly evaluations using the PSQI and Stages of Change Inventory. Sleep diaries are used throughout to monitor participants' sleep patterns. The primary outcome is sleep quality, and secondary outcomes include self-efficacy and behavioral stage of change.

Inclusion criteria

• Aged 65 years or older
• Residing in the nursing home for at least 6 months
• Scoring 4 or above on the Mini-Cog test
• Pittsburgh Sleep Quality Index (PSQI) score ≥ 5 (indicating poor sleep quality)
• No diagnosis of psychiatric disorders such as depression, bipolar disorder, or schizophrenia
• No diagnosis of serious sleep disorders such as sleep apnea or narcolepsy
• No medical condition causing frequent nocturnal awakenings, such as nocturia
• Not using antipsychotic or other medications that may affect sleep quality
• Having chronic diseases (e.g., diabetes mellitus, hypertension, coronary artery disease) that are controlled with pharmacological treatment
• No communication problems

Exclusion criteria

• Older adults unable to perform self-care independently
• Older adults with dizziness or balance problems
• Participants who are hospitalized for any reason during the follow-up or exercise sessions will be excluded from the study