Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups
Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups
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DOI：
10.2196/jmir.4115
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发表时间：
2015-09-01
影响因子：
7.4
通讯作者：
Brinkman, Willem-Paul
中科院分区：
文献类型：
--
作者：
Horsch, Corine;Lancee, Jaap;Brinkman, Willem-Paul
背景：已经提出了几种技术来支持减少失眠投诉。以用户为中心的评估这些技术可以提供洞察到相关的治疗adherence.Objective的基本因素：获得洞察到遵守技术介导的失眠治疗作为一个坚实的基础，提高这些坚持率，通过应用adherence-enhancing strategies.Methods：坚持技术介导的睡眠产品进行了研究，在三个方面。首先，进行了一项荟萃分析来调查技术介导的失眠治疗的依从性。查询了几个数据库中的技术介导的失眠治疗。在纳入和排除步骤后，检索并汇总了18项研究的数据，以获得平均依从率。接下来，进行了15个半结构化的访谈，睡眠支持技术，调查感知的坚持。最后，还介绍了几个使用虚拟睡眠教练的场景，这些场景可以支持依从率。在六个不同的焦点小组组成的潜在用户（n=15），睡眠专家（n=7），教练（n=9）的情况进行了讨论：从荟萃分析，平均治疗依从性似乎是约52%（95%CI 43%-61%）的技术介导的失眠治疗。这意味着，平均而言，有一半的治疗练习没有执行，这表明在这方面有很大的需要坚持和改进的余地。然而，接受采访的用户认为他们对睡眠产品的坚持程度很高。用户提到依赖个人承诺（即意志力）来坚持治疗。焦点小组的参与者再次确认了他们的信念，在个人的承诺，他们认为更有效的比adherence-enhancing strategies.Conclusions：虽然坚持率失眠干预措施表明广泛的改善空间，用户可能不会认为坚持是一个问题，他们认为意志力是一个有效的坚持策略。虚拟教练应该能够科普这种“坚持偏见”，并说服用户接受提高坚持率的策略，如提醒，赞美和社区建设。
Background: Several technologies have been proposed to support the reduction of insomnia complaints. A user-centered assessment of these technologies could provide insight into underlying factors related to treatment adherence.Objective: Gaining insight into adherence to technology-mediated insomnia treatment as a solid base for improving those adherence rates by applying adherence-enhancing strategies.Methods: Adherence to technology-mediated sleep products was studied in three ways. First, a meta-analysis was performed to investigate adherence rates in technology-mediated insomnia therapy. Several databases were queried for technology-mediated insomnia treatments. After inclusion and exclusion steps, data from 18 studies were retrieved and aggregated to find an average adherence rate. Next, 15 semistructured interviews about sleep-support technologies were conducted to investigate perceived adherence. Lastly, several scenarios were written about the usage of a virtual sleep coach that could support adherence rates. The scenarios were discussed in six different focus groups consisting of potential users (n=15), sleep experts (n=7), and coaches (n=9).Results: From the meta-analysis, average treatment adherence appeared to be approximately 52% (95% CI 43%-61%) for technology-mediated insomnia treatments. This means that, on average, half of the treatment exercises were not executed, suggesting there is a substantial need for adherence and room for improvement in this area. However, the users in the interviews believed they adhered quite well to their sleep products. Users mentioned relying on personal commitment (ie, willpower) for therapy adherence. Participants of the focus groups reconfirmed their belief in the effectiveness of personal commitment, which they regarded as more effective than adherence-enhancing strategies.Conclusions: Although adherence rates for insomnia interventions indicate extensive room for improvement, users might not consider adherence to be a problem; they believe willpower to be an effective adherence strategy. A virtual coach should be able to cope with this "adherence bias" and persuade users to accept adherence-enhancing strategies, such as reminders, compliments, and community building.