Sleeping Safe and Sound

Kristien Coteur, Birgitte Schoenmakers, Marc Van Nuland

Keywords: digital self-help, public health, primary care, insomnia, hypnotic medication

Background:

Insomnia, the most common sleep disorder worldwide, has seen a sharp increase in incidence, especially during COVID-19. In Belgium, adult insomnia rates increased from 30% to 71%, accompanied by an increase in the use of hypnotics and sedatives (benzodiazepine receptor agonists, BZRA) from 13% to 21%. Although cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment, barriers such as high cost, time commitment and access to CBT-I result in pharmacotherapy being commonly used. Digital CBT-I is emerging as a scalable, effective solution.

Research questions:

Primary objective is to develop a digital self-help addressing insomnia and BZRA use in collaboration with the end-users.

Method:

A participatory research project with three phases. First, the project is focused on the development of the platform, and evaluating its usability. The second phase will focus on testing its feasibility and acceptability. And in the third phase, we will create a validated implementation plan.

For the first phase, carousel workshops were organised with 3 stops: card sorting of platform content and functionalities, brainstorming about additional features, and discussion of specific design issues using the map-it toolkit. Healthy adults (18+) concerned by insomnia (including self-diagnosis) or the use of hypnotics, residing in Belgium, were eligible for participation. Field notes from these sessions were thematically analysed by two independent researchers.

Results:

Six carousel workshops were conducted, with in total 28 volunteers. Seven themes were identified: (i) Information requirements: language, layout and missing information; (ii) Gamification for motivating recurrent use; (iii) Reassurance through community, peer support and acute help upon lying awake; (iv) An overall accessible platform; (v) Personalisation in terms of co-morbidity, data tracking and tailored advice; (vi) Design: colours and logo; (vii) Safety: data privacy and moderation of the community.

Conclusions:

Our findings highlight the importance of an evidence-based, accessible platform that feels personal and can provide (peer) support.

Points for discussion:

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