Enhancing digital CBT-I to improve adherence and reduce disparities

增强数字 CBT-I 以提高依从性并减少差异

• 批准号: 10279108
• 负责人: Philip Cheng
• 金额: $ 64.43万
• 依托单位: HENRY FORD HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10279108
• 关键词: Address; Adherence; Adult; Affect; Aftercare; Assimilations; Automobile Driving; Behavioral; Cognitive Therapy; Computers; Control Groups; Data; Depression and Suicide; Devices; Disease; Education; Effectiveness; Ensure; Environment; Equilibrium; Feedback; Goals; Health; Healthcare; Individual; Information Services; Internet; Intervention; Interview; Learning; Life; Medical; Modality; Monitor; Morbidity - disease rate; Motivation; Myocardial Infarction; Nurses; Patients; Persons; PhenX Toolkit; Population; Provider; Qualitative Methods; Research; Risk; Sampling; Self Efficacy; Sleep; Sleeplessness; Socioeconomic Status; Specialist; Stress and Coping; Stroke; Structure; Tablets; Technology; Telephone; Testing; Time; Training; Work; base; behavioral health; built environment; cardiovascular disorder risk; comparison intervention; compliance behavior; design; digital; digital health; digital intervention; disparity reduction; evidence base; health disparity; health disparity populations; health literacy; high risk population; improved; innovation; low socioeconomic status; medical specialties; mortality; patient stratification; personalized medicine; response; scaffold; secondary analysis; social culture; socioeconomic disparity; telehealth; therapy design; treatment adherence; treatment disparity; treatment risk; underserved community

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.

项目概要/摘要 失眠是一种使人衰弱的疾病，会增加多种疾病的风险，影响多达三分之一的人 成年人。虽然失眠认知行为疗法（CBT-I）可以有效治疗失眠， 缺乏经过 CBT-I 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提供（dCBT-I），且功效强大；然而，现实世界的有效性 dCBT-I 因参与度较差而受到限制。超过 50% 的患者没有完成 dCBT-I 的整个疗程，并且 40% 坚持治疗的人没有遵守 dCBT-I 的关键组成部分。此外，治疗 社会经济地位较低的人的完成度和遵守度要差 2-3 倍。我们的试点数据表明 完成和遵守 dCBT-I 的差异与健康素养较低有关，健康素养定义为能力 查找、理解和使用信息和服务来为与健康相关的决策提供信息。健康素养是 对于参与自我引导的数字干预措施（例如 DCBT-I）尤其重要。 该提案是对一项旨在提高患者治疗依从性的公告的回应。我们 提出大规模干预措施，比较增强型 dCBT-I 与对照 dCBT-I 以改善治疗 按社会经济地位分层的样本的完成度和遵守情况。我们还建议测试一下效果 增强了 DCBT-I 在减少治疗依从性和完成方面的社会经济差异方面的作用。一个 该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，以及 增强治疗动机和自我效能。此外，那些有接受非治疗风险的人 完成工作转移到远程医疗辅导，重点关注为特定人群量身定制的一个关键行为组成部分 易于融入患者的日常生活。自适应组件为患者提供两种不同的 最大限度地提高参与度的治疗方式，两种方法都利用技术来增加 可达性。我们的长期目标是确保数字失眠治疗的公平有效性。对此 最后，我们的总体目标是确定如何提高 DCBT-I 的遵守和完成情况， 尤其是那些社会经济地位较低的健康差异人群。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 对于那些需要它的人。