‘Let’s talk about sleep health’ within primary care: a qualitative study of patients’ willingness to engage in psychological interventions for insomnia

Abstract

Background Cognitive behavioural therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia yet remains underutilised in general practice. Understanding patient motivations and barriers to engaging in psychological interventions for insomnia is critical. Theoretical frameworks, such as the theory of planned behaviour, are needed to identify variables related to intentions and behaviour change. Aim To explore key influences that motivate individuals’ intention to engage with psychological interventions for insomnia. Design and setting Qualitative study consisting of an online survey and interviews with 20 community-dwelling participants with insomnia aged 26–75 years residing in Victoria, Australia. Method Guided by the theory of planned behaviour, reflexive thematic analysis was used to identify factors influencing participants’ intention to engage with psychological interventions for insomnia. Results Participants reported positive attitudes towards psychological interventions for insomnia, stemming from negative beliefs about pharmacological sleep aids and the perceived benefits of a structured and evidence-based intervention. Important others positively influenced participants’ intention to engage; however, the GP influence was less consistent and often indirect. Participants believed in the efficacy of psychological interventions, but several barriers hampered their ability to benefit from them. Accessibility was identified as a key facilitator, whereas lack of knowledge and clear referral pathways were the main barriers having an impact on uptake. Conclusion This study highlights key factors influencing patients’ intention to engage in psychological interventions for insomnia as well as opportunities for GPs to support uptake and engagement. Routine conversations about sleep health are essential to reduce the burden of untreated insomnia in the community, and the active promotion of evidence-based psychological interventions is needed.