**Background:** Sleep is essential for health, and adults with diabetes are at higher risk for poor sleep quality and short sleep duration compared to those without diabetes. The Reasoned Action Approach (RAA) is a psychosocial framework that can guide the development of behavioral interventions by identifying beliefs that influence behavior. This study aimed to compare beliefs about three healthy sleep habits (HSHs)—avoiding screen use in bed, having a regular sleep schedule, and avoiding caffeine, alcohol, and cigarettes before bedtime—between adults with and without diabetes.
**Methods:** This was a cross-sectional elicitation study conducted between January 13 and March 19, 2020, in Québec, Canada. Participants were recruited via email and online advertisements, including through Diabète Québec and Les diabétiques de Québec. Inclusion criteria were adults aged 18–64 years with or without a diagnosis of type 1 (T1D) or type 2 diabetes (T2D). Exclusion criteria included pregnant women and shift workers. A total of 154 participants completed the beliefs section of a Web-based questionnaire (56 with diabetes: 31 T1D, 24 T2D, 1 missing; 98 without diabetes). Participants selected one of three HSH questionnaires to complete. Open-ended questions measured cognitive behavioral beliefs, affective behavioral beliefs, injunctive normative beliefs, descriptive normative beliefs, and control beliefs. A multistep qualitative content analysis was performed, and modal salient beliefs were identified using a 75% cumulative frequency threshold.
**Key Results:** The majority of participants selected the questionnaire about avoiding screen use in bed (32 with diabetes, 41 without), followed by having a regular sleep schedule (18 with diabetes, 33 without), and avoiding caffeine, alcohol, and cigarettes before bedtime (6 with diabetes, 24 without). Adults with diabetes were older (mean age 42.3 vs. 30.2 years, p<0.0001), more likely to be men (29.6% vs. 14.4%, p=0.02), more likely to be workers (79.3% vs. 36.5%, p<0.0001), and had higher BMI (29.3 vs. 24.1 kg/m², p<0.0001). Both groups identified positive consequences of HSHs, primarily improved sleep. A unique belief among adults with diabetes was that having a regular sleep schedule would facilitate diabetes management (e.g., "Better regularity in the time I take my medication"). Negative emotions such as stress, anxiety, and fear were common in both groups. Adults with diabetes specifically associated avoiding screen use in bed with anxiety about not knowing blood glucose levels at night. The partner was the most frequently cited individual for approval across all HSHs in both groups. Adults with diabetes also identified their doctors as approving of a regular sleep schedule. Adults with diabetes systematically identified more barriers than facilitating factors for each HSH (5 of 7 control beliefs for avoiding screen use, 5 of 7 for regular sleep schedule, 3 of 4 for avoiding caffeine/alcohol/cigarettes), while this pattern was not seen in adults without diabetes. A diabetes-specific barrier was needing electronic devices (e.g., Dexcom) to monitor blood glucose at night. Lack of motivation was a barrier unique to adults with diabetes.
**Clinical Implications:** The results suggest that avoiding screen use in bed may be the HSH to prioritize, as most participants selected it. Adults with diabetes perceive more barriers to adopting HSHs than those without diabetes, indicating that adopting these habits is more challenging for this population. Behavioral sleep interventions for adults with diabetes should address diabetes-specific concerns, such as anxiety about nocturnal glucose levels and the need for glucose monitoring devices. Interventions should also leverage the partner's influence and address ingrained habits through strategies like removing cues (e.g., putting devices outside the bedroom), behavior substitution (e.g., reading instead of screen use), reminders, and time management. The study was limited by a small sample size for some HSHs, inability to analyze differences by diabetes type, and a predominantly Caucasian female sample.