Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study

Abstract

Background As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. Objective The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. Methods During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. Results Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. Conclusions This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.

A scoping review of mobile apps for sleep management: User needs and design considerations

“…For instance, researchers developed a mobile app to deliver Sleep restriction therapy (SRT) for people with insomnia ( 20 ). Another mobile app called “MIND MORE” can help with the self-management of insomnia ( 21 ). Similar to “MIND MORE,” “Insomnia Coach” app helps people to self-manage insomnia ( 22 ).…”

Smartphones and telemedicine for older people in China: Opportunities and challenges

“…Smartphones and wearable electronic devices can be linked to effectively monitor and manage the health status of older people in real time. 5 In addition, a variety of apps eases access to social information and helps in timely communication. Smartphones and more advanced technologies promise to address healthcare disparities and assist in health management.…”

Study on the Types of Elderly Intelligent Health Management Technology and the Influencing Factors of Its Adoption

“…Parker et al found that a cerebral palsy pain management app program helped the elderly manage the pain by monitoring treatment side effects and pain degree [23]. Chung, Goransson, Lee, et al conducted following similar research, examining an app that supports cognitive behavioral therapy for insomnia [24]. Another app helps the elderly receive home care [25], and a health management app uses mobile health technology and health games [26].…”

“…The older the elderly, the worse their performance [12,28,[44][45][46] Education level Populations with a high education level tend to use new technology [28,47] Region Compared to urban residents, rural ones are not likely to use new technology [48] E-health literacy E-health literacy is considered as a prerequisite of using mobile health app [5,15,30,47,49] Information literacy People skilled in computer and Internet use tend to adopt IHMT [13,14,38,46] Ethnicity and language Ethnic and linguistic differences affect users' acceptance and use behavior [13,44] Physical difficulties Physical difficulties are an obstacle for the elderly to accept new technologies [9] Self-efficacy People with high efficacy are more willing to accept new technology [11,13,16,30,39,45,[49][50][51] Compliance Procedures/equipment that can improve compliance are easy to be continuously used [19,24,29,[52][53][54][55] Skeptical attitudes Skepticism is a barrier to the elderly using new technology [12] Perceived demand Perceived demand is an essential factor in promoting the use of intelligent health management devices [8,21,56] 1. Objective factors…”

“…In addition, as an essential index to evaluate the effect of IHMT, compliance can subjectively improve the health of the elderly. For example, Chung et al, summarized that cognitive behavioral therapy for insomnia app is usable among older users and can improve subjective sleep quality after a 1 week self-help intervention period [24]. Furthermore, Mira et al's study showed that a medication self-management app (called Alice) improves patients' compliance, helps to reduce the forgetting rate and medication error rate, and improves the perceived independence of drug management [52].…”