A secondary analysis of the role of geography in engagement and outcomes in a clinical trial of an efficacious Internet intervention for insomnia.
A secondary analysis of the role of geography in engagement and outcomes in a clinical trial of an efficacious Internet intervention for insomnia.
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在一项有效的互联网干预失眠的临床试验中，对地理在参与度和结果中的作用进行了二次分析。
DOI：
10.1016/j.invent.2019.100294
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Ritterband,LeeM
中科院分区：
文献类型：
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作者：
Chow,PhilipI;Gonzalez,BrianD;Ingersoll,KarenS;Thorndike,FrancesP;Shaffer,KellyM;Camacho,Fabian;Perlis,MichaelL;Ritterband,LeeM
背景在线失眠干预措施可以增加那些获得服务机会有限的人获得治疗的机会。目前尚不清楚的是，来自较偏僻（相对于人口较稠密）地区的个人是否会参与在线干预并从中受益。这项二次分析检查了地理指数与有效的全自动在线失眠认知行为疗法 (CBTsingle bondI) 计划（使用互联网健康睡眠-SHUTi）的参与度和结果之间的关系。Method303 参与者 (Mage= 43.3;SD= 11.6) 被随机分配到 SHUTi 或在线患者教育条件，并在基线和干预后进行评估。参与者的农村代码是使用参与者邮政编码确定的。与最近的睡眠药物提供者的距离计算为最近的提供者城市中心（来自公开的 CBT-I 提供者列表）与参与者邮政编码中心之间的距离。依从性结果是干预核心完成次数、睡眠日记和登录次数。睡眠结果是失眠的严重程度以及从在线睡眠日记中得出的入睡潜伏期和入睡后的觉醒。结果个体来自不同的地理位置。大多数人居住在人口相当稠密的地区；然而，距最近的睡眠药物提供者的距离存在很大差异。研究结果表明，SHUTi 的功效、依从性和参与度不受人们居住地点的影响。控制年龄和性别不会影响地理变量（即距离、乡村性）与依从性或睡眠相关结果之间的任何关系。结论互联网干预措施必须证明它们可以克服地理带来的障碍。这是第一项研究参与者的地理位置及其与在线 CBT-I 的参与和结果之间的关系的研究。
BackgroundOnline interventions for insomnia can increase access to treatments for those with limited access to services. What remains unknown is whether individuals from more isolated (vs. more densely populated) regions engage with, and benefit as much from, an online intervention. This secondary analysis examined the relationship of geographical indices with engagement and outcomes of an efficacious, fully automated online cognitive behavioral therapy for insomnia (CBTsingle bondI) program (Sleep Healthy Using the Internet-SHUTi).Method303 participants (Mage= 43.3;SD= 11.6) were randomly assigned to SHUTi or an online patient education condition and assessed at baseline and post intervention. Rural code of participants was determined using participant zip codes. Distance to the nearest sleep medicine provider was calculated as the distance between the center of the nearest provider's city (from a publicly available list of CBT-I providers) and the center of the participants' zip code. Adherence outcomes were number of intervention core completions, sleep diaries, and logins. Sleep outcomes were insomnia severity as well as sleep onset latency and wake after sleep onset derived from online sleep diaries.ResultsIndividuals were from a range of geographic locations. Most lived in fairly densely populated areas; however, there was a large variation in distance to the nearest sleep medicine provider. Findings indicate that the efficacy, adherence, and engagement with SHUTi were not impacted by where people lived. Controlling for age and gender did not impact any of the relationships among geography variables (i.e., distance, ruralness) and adherence or sleep related outcomes.ConclusionsInternet interventions must demonstrate that they can overcome obstacles posed by geography. This is the first study to examine the geographic location of participants and its association with engagement with, and outcomes of, online CBT-I.