JMIR Publications

ABSTRACT

Background:

The efficacy of cognitive behavioral therapy for insomnia (CBT-I) has been well-established in older adults. Recently, the utilization of mobile CBT-I apps is getting attention from mental health professionals and researchers. Nevertheless, whether mobile CBT-I apps are usable among older users has yet to be first determined.

Objective:

The aims of this study were (1) to explore the relationship between subjective sleep quality and subjective memory complaints and depressive symptoms and that 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, (2) to compare changes in their subjective sleep quality from pre- to post intervention using the mobile app over an one-week intervention period, and (3) to finally evaluate the adherence to it.

Methods:

During the 2-hour one-day training program 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 the hands-on experience on the app with the help of therapists and volunteer workers, and then to fill out the questionnaires on sociodemographic characteristics and subjective evaluation of mental health status and app usability. For the one-week home-based self-help CBT-I using the app (post-intervention), 9 of 41 program attendants, who already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the one-week prevention, particularly 8 days after the training program ended.

Results:

Due to the missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows: (1) poor subjective sleep quality was associated with higher ratings of depressive symptoms (N=40; ρ=0.60, P<.001) and memory complaints (N=40; ρ=0.46, P=.003) at baseline; (2) those who perceived mobile app use as more difficult in everyday life were more likely to have difficulty in learning how to use the MIND MORE app (N=40; r=-0.37, P=.02); (3) significant improvements in their subjective sleep quality from pre- to post-intervention were observed in those older adults by using the MIND MORE app only for the one-week intervention period (N=9; t8=3.74, P=.006); (3) apart from the 5 program attendants who had no smartphones (2/40) and withdrew from their MIND MORE membership (3/40), 37% (13/35) of those in the one-day sleep education program showed the adherence to the app not only for at least 2 weeks, but also over up to 8 weeks (2/35, 6%) without any further contact.

Conclusions:

This study provided empirical evidence to support the potential uptake of the newly developed, commercial MIND MORE app in older adults living in an urban community and to implement the next phase of app transformation.