Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups.
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.
Interactive Intelligence, Delft University of Technology, Delft, Netherlands. c.h.g.horsch@tudelft.nl.
Corine
http://orcid.org/0000-0001-7595-8641
C
Horsch
Jaap
http://orcid.org/0000-0002-7722-5780
J
Lancee
Robbert Jan
http://orcid.org/0000-0002-8628-6446
RJ
Beun
Mark A
http://orcid.org/0000-0002-8161-5722
MA
Neerincx
Willem-Paul
http://orcid.org/0000-0001-8485-7092
WP
Brinkman
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005260:Female; D017144:Focus Groups / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D055815:Young Adult
focus groups; interview; meta-analysis; mobile apps; patient compliance; sleep initiation and maintenance disorders; user-computer interface