Enhancing digital CBT-I to improve adherence and reduce disparities

项目总结/摘要 失眠是一种使人衰弱的疾病，会增加患多种疾病的风险， 成年人了虽然失眠可以有效地治疗与认知行为疗法的失眠（CBT-I）， 缺乏接受过CBT-1培训的专业提供者。因此，大多数失眠患者 无法接受CBT-I作为推荐的失眠一线干预措施。为了解决这个问题， CBT-I现在可以以数字方式（dCBT-I）提供强大的功效;然而， dCBT-I受限于接合不良。超过50%的患者没有完成dCBT-I的整个疗程， 40%坚持治疗的患者不坚持dCBT-I的关键成分。此外，治疗 社会经济地位低的人完成学业和坚持学业的情况要差2-3倍。我们的飞行员数据显示 完成和坚持dCBT-I的差异与低健康素养有关，定义为能力 查找、理解和使用信息和服务，为健康相关决策提供信息。健康素养是 对于参与自我指导的数字干预措施（如dCBT-I）尤为重要。 该提案是对一项旨在提高患者对治疗依从性的公告的回应。我们 提出一项大规模干预措施，将增强型dCBT-I与对照型dCBT-I在改善治疗方面进行比较 完成和遵守的样本分层的社会经济地位。我们还建议测试 加强dCBT-I，减少治疗依从性和完成方面的社会经济差异。一个 这项试验的创新部分是使用非专业教练作为低健康素养的支架， 提高治疗动机和自我效能。此外，那些有治疗风险的人， 完成转移到远程保健教练集中在一个单一的关键行为组件量身定制， 融入患者的日常生活。自适应组件为患者提供两种不同的 治疗模式，以最大限度地提高参与度，这两种方法都利用技术， 可访问性。我们的长期目标是确保数字失眠治疗的公平有效性。与 最后，我们的总体目标是确定如何提高dCBT-I的依从性和完成率， 特别是在那些作为健康差异人群的社会经济地位低的人群中。根据试点数据，我们的中心假设 与对照dCBT-I相比，增强型dCBT-I将通过提供有针对性的支持来提高参与度 给需要的人

PROJECT SUMMARY/ABSTRACT Insomnia is a debilitating condition that escalates risk of a myriad of disorders, and affects up to one third of adults. Although insomnia can be effectively treated with Cognitive Behavioral Therapy for Insomnia (CBT-I), there is a shortage of specialty providers trained in CBT-I. Consequently, most patients with insomnia are unable to receive CBT-I as the recommended first-line intervention for insomnia. To address this problem, CBT-I can now be delivered digitally (dCBT-I) with strong efficacy; however, the real-world effectiveness of dCBT-I is limited by poor engagement. Over 50% of patients do not complete the full course of dCBT-I, and 40% of those who persist in treatment do not adhere to critical components of dCBT-I. Moreover, treatment completion and adherence are 2-3 times worse in those with low socioeconomic status. Our pilot data indicate that the disparity in completion and adherence to dCBT-I is related to low health literacy, defined as the ability to find, understand, and use information and services to inform health-related decisions. Health literacy is especially critical for engagement with digital interventions that are self-guided, such as dCBT-I. This proposal responds to an announcement focused on improving patient adherence to treatments. We propose a large-scale intervention comparing enhanced dCBT-I to control dCBT-I in improving treatment completion and adherence in a sample stratified by socioeconomic status. We also propose to test the effect of enhanced dCBT-I on reducing socioeconomic disparities in treatment adherence and completion. An innovative component of this trial is the use of non-specialist coaches as a scaffold for low health literacy, and to enhance treatment motivation and self-efficacy. Furthermore, those who are at-risk for treatment non- completion are shifted to telehealth coaching focused on one single critical behavioral component tailored for ease of assimilation into the patient’s daily life. The adaptive component provides patients two different treatment modalities to maximize engagement and both approaches leverage technology to increase accessibility. Our long-term goal is to ensure equitable effectiveness of digital insomnia treatments. To that end, our overall objective is to determine how adherence and completion in dCBT-I can be improved, particularly in those with low SES as a health disparities population. Based on pilot data, our central hypothesis is that, compared to control dCBT-I, enhanced dCBT-I will increase engagement by providing targeted support for those who need it.