JMIR Publications

ABSTRACT

Background:

Individuals enrolling in the Veterans Health Administration (VHA) frequently report symptoms consistent with insomnia disorder. CBT for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the VA has successfully implemented a large dissemination effort to train providers in CBT-I, the number of trained CBT-I providers continues to limit the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy to traditional CBT-I. In order to help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS).

Objective:

To describe the use of evaluation panels of Veterans and spouses of Veterans during the development of PTBS. Specifically, we report on the methods employed to conduct those panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS.

Methods:

A communications firm was contracted to recruit three Veteran (n = 27) and two spouse of Veteran (n = 18) panels and to convene them for three one-hour meetings each. Members of the VA team identified key questions for the panels and the communications firm prepared facilitator guides to elicit feedback on those key questions. The guides provided a script for the facilitators to follow while convening the panels. The panels were conducted telephonically, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing panelists’ feedback during each of the panel meetings: the qualitative feedback described in those reports served as the raw material for the present study.

Results:

The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to: (a) emphasize the efficacy of CBT-I techniques; (b) clarify and simplify written content as much as possible, and (c) make sure that content is consistent with the lived experiences of Veterans. Their feedback was congruent with previous studies of factors that influence user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course’s sleep diary function, making written content more concise, and selecting Veteran testimonial videos which emphasized the benefits of treating chronic insomnia symptoms.

Conclusions:

Veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was employed to make concrete revisions and design decisions that were consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers.