Henry Ford Health, Novi, Michigan, USA.
Henry Ford Health, Novi, Michigan, USA.
Sleep Health. 2023 Oct;9(5):571-578. doi: 10.1016/j.sleh.2023.07.003. Epub 2023 Aug 24.
Digital cognitive behavioral therapy for insomnia has significant advantages for dissemination and scalability vs. in-person cognitive behavioral therapy for insomnia and is, therefore, well-positioned to be the first-line intervention for insomnia. However, only about half of patients remit following digital cognitive behavioral therapy for insomnia. Evidence suggests that treatment engagement is a critical driver of digital cognitive behavioral therapy for insomnia effectiveness, and barriers to engagement disproportionately impact people from under-resourced communities. For digital cognitive behavioral therapy for insomnia to be effective and scalable, we need to identify facilitators and barriers to digital cognitive behavioral therapy for insomnia engagement.
Responses from an exit survey about participant experiences with digital cognitive behavioral therapy for insomnia were analyzed using mixed methods. The survey included quantitative measures of treatment engagement and a free-response item, which was coded and analyzed for themes using both inductive and deductive approaches.
Analyses revealed five themes that were relevant for engagement: (1) digital person-to-person components, (2) type and extent of information, (3) user's sense of autonomy, (4) app functionality, and (5) importance of tailored content. Facilitators included enjoyment of digital cognitive behavioral therapy for insomnia elements, particularly those that enhanced a sense of connection (eg, a digital therapist avatar); content presented clearly and at an appropriate pace; and smooth app functionality. Barriers included desire for additional human support, perception that digital cognitive behavioral therapy for insomnia did not account for clinical complexities, and factors that interfered with implementation of key treatment recommendations.
Many barriers and facilitators are influenced by health literacy and technological literacy. Those with access to health and technological literacy are better equipped to engage with digital cognitive behavioral therapy for insomnia. Recommendations for adaptations and enhancements are discussed.
与面对面的失眠认知行为疗法相比，数字化认知行为疗法在传播和可扩展性方面具有显著优势，因此非常适合作为失眠的一线干预手段。然而，只有大约一半的患者在接受数字化认知行为疗法治疗后症状缓解。有证据表明，治疗参与度是数字化认知行为疗法治疗失眠效果的关键驱动因素，而参与障碍会不成比例地影响资源匮乏社区的人群。为了使数字化认知行为疗法有效且可扩展，我们需要确定影响其参与度的促进因素和障碍。
对参与者对数字化认知行为疗法体验的退出调查的回复使用混合方法进行了分析。该调查包括治疗参与度的定量测量和一个自由回答项目，该项目使用归纳和演绎方法进行了编码和主题分析。
分析揭示了与参与度相关的五个主题：（1）数字化人际互动组件；（2）信息的类型和程度；（3）用户的自主权感；（4）应用程序功能；（5）量身定制内容的重要性。促进因素包括对数字化认知行为疗法元素的享受，特别是那些增强连接感的元素（例如，数字化治疗师头像）；内容清晰且以适当的速度呈现；以及流畅的应用程序功能。障碍包括对额外的人际支持的需求、认为数字化认知行为疗法没有考虑到临床复杂性的看法，以及干扰关键治疗建议实施的因素。
许多障碍和促进因素受到健康素养和技术素养的影响。那些有机会获得健康和技术素养的人更有能力参与数字化认知行为疗法。讨论了适应和增强的建议。
