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. 2020 Aug 24;8(8):e17755.
doi: 10.2196/17755.

Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study

Kyungmi Chung  1   2   3 , Seoyoung Kim  4 , Eun Lee  3   5 , Jin Young Park  1   2   3
Affiliations

Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study

Kyungmi Chung et al. JMIR Mhealth Uhealth. .

Abstract

Background: As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined.

Objective: The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone-based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app.

Methods: During the 2-hour training program delivered on 1 day titled "Overcoming insomnia without medication: How to use the 'MIND MORE' mobile app for systematic self-management of insomnia" (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended.

Results: Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact.

Conclusions: This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.

Keywords: cognitive behavioral therapy; community mental health services; health care quality, access, and evaluation; health education; health services for the aged; mobile apps; sleep hygiene; sleep initiation and maintenance disorders; telemedicine; treatment adherence and compliance.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Sleep hygiene education program with 3 main sessions.
Figure 2
Figure 2
Quiz session after the end of each of the 3 main sleep education sessions.
Figure 3
Figure 3
Sleep diary.
Figure 4
Figure 4
Cognitive therapy with (A) thought record and (B) constructive worry worksheet.
Figure 5
Figure 5
Additional features of the MIND MORE app: (A) learning progress management, (B) clipping button, and (C) list of clipped pages.
Figure 6
Figure 6
Scatter plots showing the Spearman rank correlations (n=40) between (A) subjective sleep quality and subjective memory complaints and (B) subjective sleep quality and self-reported depressive symptom severity. PSQI-K: Korean version of the Pittsburgh Sleep Quality Index; SGDS-K: Korean version of the 15-question Geriatric Depression Scale; SMCQ: Subjective Memory Complaints Questionnaire.
See this image and copyright information in PMC

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