Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study

Abstract

Background\ud Insomnia is a common psychological complaint. Cognitive behavioural therapy for insomnia (CBT-I), although effective, is little used because of lack of trained providers. Computerised CBT-I (CCBT-I) may be a solution to this shortfall in access.\ud Aim\ud To explore patient and health professional perspectives and the role of social networking, to develop a novel CCBT-I programme to increase access to this form of intervention.\ud Design and setting\ud Qualitative methods underpinned by the theory of planned behaviour in primary care in Lincolnshire and Nottinghamshire.\ud Method\ud Semi-structured interviews and focus groups with a purposive sample of health professionals and adults with insomnia.\ud Results\ud A total of 23 health professionals and 28 patients were interviewed. Features designed to engender trust and improve functionality were perceived to improve uptake and adherence to CCBT-I. Trust lay in programme accreditation; for professionals, trust derived from evidence of effectiveness; for patients, trust depended on the doctor-patient relationship, professional support, the quality of online peer support, and perceptions of risk. Patients wanted mobile applications; access in short periods; self-assessment; interactive, personalised information on sleep; and moderated contact with other users. Patients and practitioners differed over whether useful information could be distinguished from less useful or potentially incorrect information.\ud Conclusion\ud Improving uptake and adherence to online programmes for insomnia requires design features focusing on trust and functionality. Enabling greater patient control and interaction with other users and professionals may stimulate positive experiences of online therapy. CCBT-I would enable greater access to treatment but is limited by lack of online access or poor computer literacy

Qualitative studies of insomnia: Current state of knowledge in the field

“…Of the 22 studies retained in this review, four articles provided no or incomplete information on participants’ sociodemographic characteristics (age and gender) [33–35, 37] and one provided no information on data analyses [38]. Twenty studies focused on patients only, two studies focused on health care professionals 1 only [33, 36], four studies included both patients and health care professionals [16, 34, 35, 37], and one study included healthy controls [38].…”

“…Twenty studies focused on patients only, two studies focused on health care professionals 1 only [33, 36], four studies included both patients and health care professionals [16, 34, 35, 37], and one study included healthy controls [38]. Data were collected mainly through semi-structured interviews ( n = 14) and focus groups ( n = 12).…”

“…Data were collected mainly through semi-structured interviews ( n = 14) and focus groups ( n = 12). Four studies used both individual interviews and focus groups [34, 35, 37, 39]. Audio-diaries were used in one study [40].…”

“…Of the 22 studies, six were rated as “excellent” for their methodological quality according to the CASP criteria [33, 39, 44–47], 14 studies were rated as “very good” [16, 17, 35–37, 40–43, 48–51], two were rated as “good” [34, 38], and none was ranked as “poor”. In general, studies retained for this review presented several strengths according to qualitative methodology standards.…”

“…The questionnaire included two screening questions (aims of the research and appropriateness of qualitative study methodology) and 10 specific questions that appraised the quality of the qualitative methodology (e.g., member check, reaching saturation, procedure for identification of research themes). Indeed, this modified version is deemed effective in appraising qualitative studies [33–35]. For the purposes of the present review, studies with a score between “10” and “12” are considered as presenting an “excellent” methodological quality rigor; a score between “7” and “9” as “very good”; a score between “4” and “6” as “good”; and a score of “3” and less as “poor”.…”