JMIR Publications

ABSTRACT

Background:

Breast cancer survivors (BCS) are a growing population with a higher prevalence of insomnia women of the same age without a history of cancer. Cognitive behavioral therapy for insomnia (CBT-I) has shown efficacy in this population, but it is not widely available to those who need it.

Objective:

We set out to better understand breast cancer survivor experiences with insomnia and to explore the feasibility and acceptability of delivering CBT-I using a virtual assistant (Amazon Alexa).

Methods:

We first conducted a formative phase with two focus groups, supplemented with three in-depth interviews to understand BCS perceptions of insomnia, as well as interest in and comfort with using a virtual assistant to learn about CBT-I. We then developed a prototype incorporating participant preferences and CBT-I components, and demonstrated it in group and individual settings to BCS to evaluate acceptability, interest, perceived feasibility, educational potential, and usability of the prototype. We also collected open-ended feedback on the content. We used frequencies to describe quantitative data.

Results:

We recruited n=11 BCS with insomnia to participate in the formative phase and n=14 to participate in the prototype demonstration and feedback. In formative work, anxiety and fear came up as causes of insomnia, as well as hot flashes. After prototype demonstration, nearly 79% of participants reported interest and feasibility of using the Alexa to record sleep patterns. Nearly two thirds thought lifestyle modification (64.3%) and sleep restriction (64.3%) would be feasible and were interested in this feature on the Alexa program (71.4% and 64.3%, respectively). Relaxation exercises were rated of interest and feasible using the Alexa by 71.4% of participants. Usability was rated as better than average and all women reported that they would recommend the program to friends and family.

Conclusions:

This virtual assistant prototype delivering CBT-I components by smart speaker was rated as feasible and acceptable, suggesting that this prototype should be fully developed and tested for efficacy in the BCS population. If efficacy is shown in this population, the prototype should also be adapted for other high-risk populations. Clinical Trial: n/a