Using eHealth to Expand Access to Cognitive Behavioral Therapy for Insomnia in Hispanic Primary Care Patients (New York)

Project Details - Ongoing

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Chronic insomnia is a significant public health burden and is associated with increased morbidity, mortality, and high economic costs. Insomnia affects over 30 million US adults, most of whom seek care in the primary care setting. While Hispanics are at greater risk for insomnia than Whites, access to the recommended first-line treatment, cognitive behavioral therapy for insomnia (CBT-I), is limited. Lack of qualified bilingual behavioral providers and high costs are two key factors that limit access. Advances in self-guided electronic health (eHealth) treatments represent an innovative and scalable means to address mental health care disparities; however, its implementation in underserved communities has not been implemented.

This project will evaluate the effectiveness of the Spanish-language version of a self-guided, eHealth CBT-I course versus a culturally adapted version. This is an interactive and tailored web- and mobile-based program modeled on the primary tenets of face-to-face CBT-I, which have demonstrated effectiveness at reducing insomnia symptoms. Participants will be recruited from primary care practices within the diverse New York Presbyterian Hospital System.

The specific aims of the project are as follows:

  • To examine the effectiveness of a culturally adapted online CBT-I program compared to enhanced usual care. 
  • To identify organizational, patient, and provider barriers and facilitators to implementation of the adapted CBT-I eHealth intervention. 
  • To determine the cost-effectiveness of delivering the adapted eHealth CBT-I intervention versus enhanced usual care in the primary care setting. 

By leveraging recent advances in eHealth and capitalizing on the increasing rates of Internet use among Hispanic adults, this study has the potential to expand access to evidence-based alternatives to pharmacotherapy for the management of chronic insomnia, and to narrow existing racial and ethnic disparities in access to high-quality behavioral health care for primary care patients. Researchers hypothesize that the adapted CBT-I eHealth intervention will result in improved Insomnia Severity Index scores, and that it will result in greater improvements in quality of life. Findings will identify viable implementation strategies for the successful integration of an eHealth version of CBT-I into the primary care setting and may have implications for other use cases involving the implementation of such interventions in Spanish-speaking patients.

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