Using the Behaviour Change Wheel to Develop a Tailored Intervention to Overcome General Practitioners' Perceived Barriers to Referring Insomnia Patients to Digital Therapeutic Sleepio

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2024 Aug 22

PMID 39174968

Authors

Ohoud Alkhaldi

Brian McMillan

John Ainsworth

Affiliations

Soon will be listed here.

Abstract

Background: Digital therapeutic Sleepio has proven effective in improving sleep quality and decreasing symptoms of anxiety. The National Institute for Health and Care Excellence (NICE) guidance recommends Sleepio as an alternative treatment to usual sleep hygiene education and hypnotic medications. General practitioners (GPs) play a critical role in the adoption of digital therapeutics in patient care. Previous interventions did not adopt theoretical frameworks to systematically understand GPs behaviour toward referring patients to digital therapeutics.

Objectives: This study aimed to report the systematic and comprehensive development of an intervention to encourage GPs to refer insomnia patients to Sleepio, using the Behaviour Change Wheel (BCW).

Methods: The eight steps outlined in the BCW were followed to develop an intervention. The Capability Opportunity Motivation-Behaviour Self-Evaluation Questionnaire (COM-B-Qv1) was adopted to understand GPs perceived facilitators and barriers to refer insomnia patients to Sleepio. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate changes in GPs' behaviour in relation to Sleepio.

Results: The BCW design process resulted in the identification of five intervention functions, three policy categories and five behaviour change techniques (BCTs) as potential active components for an intervention. The intervention includes providing GPs with an orientation about using Sleepio to improve their knowledge and confidence, sending visual reminders to GPs to recommend Sleepio to their patients, providing ongoing technical support.

Conclusion: The BCW can be successfully applied through a systematic process to understand the drivers of GPs' behaviour and to develop an intervention that can encourage them to refer insomnia patients to Sleepio.

References

Panneman M, Goettsch W, Kramarz P, Herings R . The costs of benzodiazepine-associated hospital-treated fall Injuries in the EU: a Pharmo study. Drugs Aging. 2003; 20(11):833-9. DOI: 10.2165/00002512-200320110-00004. View

Henry A, Miller C, Emsley R, Sheaves B, Freeman D, Luik A . Does treating insomnia with digital cognitive behavioural therapy (Sleepio) mediate improvements in anxiety for those with insomnia and comorbid anxiety? An analysis using individual participant data from two large randomised controlled trials. J Affect Disord. 2023; 339:58-63. DOI: 10.1016/j.jad.2023.06.053. View

Madari S, Golebiowski R, Mansukhani M, Kolla B . Pharmacological Management of Insomnia. Neurotherapeutics. 2021; 18(1):44-52. PMC: 8116439. DOI: 10.1007/s13311-021-01010-z. View

Reid H, Smith R, Williamson W, Baldock J, Caterson J, Kluzek S . Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare. BMC Public Health. 2022; 22(1):1784. PMC: 9487060. DOI: 10.1186/s12889-022-14178-6. View

Saddichha S . Diagnosis and treatment of chronic insomnia. Ann Indian Acad Neurol. 2010; 13(2):94-102. PMC: 2924526. DOI: 10.4103/0972-2327.64628. View

Sarradon-Eck A, Bouchez T, Auroy L, Schuers M, Darmon D . Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study. JMIR Mhealth Uhealth. 2021; 9(3):e21795. PMC: 7974757. DOI: 10.2196/21795. View

Mather M, Pettigrew L, Navaratnam S . Barriers and facilitators to clinical behaviour change by primary care practitioners: a theory-informed systematic review of reviews using the Theoretical Domains Framework and Behaviour Change Wheel. Syst Rev. 2022; 11(1):180. PMC: 9429279. DOI: 10.1186/s13643-022-02030-2. View

Lopez Segui F, Pratdepadua Bufill C, Abdon Gimenez N, Martinez Roldan J, Garcia Cuyas F . The Prescription of Mobile Apps by Primary Care Teams: A Pilot Project in Catalonia. JMIR Mhealth Uhealth. 2018; 6(6):e10701. PMC: 6035343. DOI: 10.2196/10701. View

Neutel C, Perry S, Maxwell C . Medication use and risk of falls. Pharmacoepidemiol Drug Saf. 2002; 11(2):97-104. DOI: 10.1002/pds.686. View

10.

Byambasuren O, Beller E, Glasziou P . Current Knowledge and Adoption of Mobile Health Apps Among Australian General Practitioners: Survey Study. JMIR Mhealth Uhealth. 2019; 7(6):e13199. PMC: 6592476. DOI: 10.2196/13199. View

11.

Sampson C, Bell E, Cole A, Miller C, Marriott T, Williams M . Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis. BJGP Open. 2021; 6(2). PMC: 9447315. DOI: 10.3399/BJGPO.2021.0146. View

12.

Leigh S, Ashall-Payne L, Andrews T . Barriers and Facilitators to the Adoption of Mobile Health Among Health Care Professionals From the United Kingdom: Discrete Choice Experiment. JMIR Mhealth Uhealth. 2020; 8(7):e17704. PMC: 7381009. DOI: 10.2196/17704. View

13.

Espie C, Emsley R, Kyle S, Gordon C, Drake C, Siriwardena A . Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial. JAMA Psychiatry. 2018; 76(1):21-30. PMC: 6583463. DOI: 10.1001/jamapsychiatry.2018.2745. View

14.

Atkins L, Francis J, Islam R, OConnor D, Patey A, Ivers N . A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017; 12(1):77. PMC: 5480145. DOI: 10.1186/s13012-017-0605-9. View

15.

Makhni S, Zlatopolsky R, Fasihuddin F, Aponte M, Rogers J, Atreja A . Usability and Learnability of RxUniverse, an Enterprise-Wide App Prescribing Platform Used in an Academic Tertiary Care Hospital. AMIA Annu Symp Proc. 2018; 2017:1225-1232. PMC: 5977607. View

16.

Slevin P, Kessie T, Cullen J, Butler M, Donnelly S, Caulfield B . A qualitative study of chronic obstructive pulmonary disease patient perceptions of the barriers and facilitators to adopting digital health technology. Digit Health. 2019; 5:2055207619871729. PMC: 6710666. DOI: 10.1177/2055207619871729. View

17.

Byambasuren O, Beller E, Hoffmann T, Glasziou P . mHealth App Prescription in Australian General Practice: Pre-Post Study. JMIR Mhealth Uhealth. 2020; 8(6):e16497. PMC: 7296416. DOI: 10.2196/16497. View

18.

Chen J, Allman-Farinelli M . Impact of Training and Integration of Apps Into Dietetic Practice on Dietitians' Self-Efficacy With Using Mobile Health Apps and Patient Satisfaction. JMIR Mhealth Uhealth. 2019; 7(3):e12349. PMC: 6421514. DOI: 10.2196/12349. View

19.

Espie C, Kyle S, Williams C, Ong J, Douglas N, Hames P . A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep. 2012; 35(6):769-81. PMC: 3353040. DOI: 10.5665/sleep.1872. View

20.

Michie S, van Stralen M, West R . The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6:42. PMC: 3096582. DOI: 10.1186/1748-5908-6-42. View