P689. Improving Treatment Effectiveness in Marginalized Individuals: Facilitators and Barriers to Digital Cognitive Behavioral Therapy for Insomnia

Document Type

Conference Proceeding

Publication Date


Publication Title

Biol Psychiatry


Background: Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) is a highly effective treatment self-guided mHealth treatment for insomnia; however, completion and adherence rates are poor, especially among marginalized individuals. The present study aimed to explore facilitators and barriers to dCBT-I.

Methods: Thematic analysis was conducted on qualitative data collected in those who engaged with dCBT-I. A total of 151 written feedback, 34 individual interviews, and 1 focus group of six racial minorities with low socioeconomic status (SES) was used.

Results: Five themes emerged: digital person to person component, type and extent of information, users’ sense of autonomy, app functionality, and importance of tailored content. The majority of participants across demographic groups rated the virtual therapist positive. Users felt that the app was engaging and that the information was understandable and well-paced. Users liked the flexibility of the self-guided program; however a subset of participants were not able to benefit from this feature, likely due to lower health literacy in those with lower SES, this subset comprised those with lower health literacy and SES. This population also reported lower self-efficacy and was significantly in favor of wanting more personalized support. Conclusions: Although dCBT-I has high accessibility and scalability, low health literacy may be a barrier treatment completion, especially for individuals with low SES. This suggests that enhanced support, such as providing more personalized support and tailored content, can improve treatment adherence and completion.

Medical Subject Headings

Insomnia, Cognitive Behavioral Therapy, mHealth





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