Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups

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Abstract

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.

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Author and article information

Contributors

Corine Horsch:

Interactive IntelligenceDelft University of TechnologyEWI HB, 12th FloorMekelweg 4Delft, 2628 CDNetherlands31 15278414531 152787141c.h.g.horsch@tudelft.nl

ORCID: http://orcid.org/0000-0001-7595-8641

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications Inc. (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: September 2015

Publication date (Electronic): 04 September 2015

Volume: 17

Issue: 9

Electronic Location Identifier: e214

Affiliations

[1] ¹Interactive Intelligence Delft University of Technology DelftNetherlands

[2] ²Department of Clinical Psychology University of Amsterdam AmsterdamNetherlands

[3] ³Interaction Technology Utrecht University UtrechtNetherlands

Author notes

Corresponding Author: Corine Horsch c.h.g.horsch@ 123456tudelft.nl

Author information

Corine Horsch http://orcid.org/0000-0001-7595-8641

Jaap Lancee http://orcid.org/0000-0002-7722-5780

Robbert Jan Beun http://orcid.org/0000-0002-8628-6446

Mark A Neerincx http://orcid.org/0000-0002-8161-5722

Willem-Paul Brinkman http://orcid.org/0000-0001-8485-7092

Article

Publisher ID: v17i9e214

DOI: 10.2196/jmir.4115

PMC ID: 4642391

PubMed ID: 26341671

SO-VID: 028cc58e-002e-49df-8747-4ad5948a7483

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 6 December 2014

Date revision requested : 21 April 2015

Date revision received : 3 June 2015

Date accepted : 24 June 2015

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