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The Hit-IT project: The development and evaluation of an internet-based complex intervention for primary healthcare patients with cardiovascular disease and insomnia
Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.ORCID iD: 0000-0001-9100-2674
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Sustainable development
Sustainable Development
Abstract [en]

There is a need to explore insomnia among patients with cardiovascular disease (CVD), since they have increased risk for disease deterioration, poor quality of life and a shorter lifetime expectancy. Cognitive behavioral therapy (CBT) is the main recommended insomnia treatment, although it is a rare treatment choice in the healthcare due to lack of certified CBT therapists.

The aim of the thesis was therefore to investigate a nurse-led internet-based CBT for insomnia (I-CBTI) tailored for patients with CVD, that includes qualitative and quantitative measures to explore the patients’ characteristics and treatment motive, insomnia experience, treatment effect, adherence and the usability of a complex intervention called the Hit-IT program.

The first paper had a mixed study design to investigate the participants (n=126) sleep, physical and psychological characteristics in relation to insomnia via baseline questionnaires, as well as interviews (n=19) covering their motivation and expectations when participating in the Hit-IT treatment study. The second paper was a qualitative study using a Critical incident technique, to capture the experience of the participants (n=20) with CVD and insomnia sleep situation, and determine how they managed their insomnia. The third paper included 48 participants who were randomised to test the nine-week nurse-led I-CBTI treatment, tailored for patients with CVD or a three-week of self-studies (control group) without support. Paper four was a qualitative study to explore the experience and management of the Hit-IT program.

The thesis findings showed that the participants were primarily male participants of older age, and that insomnia symptoms were significantly associated with worse somatic symptom severity, reduced physical quality of life, increased levels of depressive symptoms and cardiac anxiety. The participants were motivated to engage in the Hit-IT study, but were concerned the comorbid condition would be a hindering factor for the required behavioral change if randomized to the nine-week Hit-IT program. The participants also experience physical and cognitive insomnia triggers caused by cardiac symptoms at night. However, the participants in the Hit-IT program group significantly improved their insomnia symptoms compared to the three-week self-study control group. Also, the participants adherent to the Hit-IT program significantly increased their physical quality of life compared to those not adherent to treatment. Moreover, the results showed that the participants had trust in the Hit-IT program and experienced the intervention as very interesting yet challenging. The major treatment adherence facilitator was to experience improved sleep during the course of treatment.

The thesis findings conclude that nurses have the skills to deliver a nurse-led I-CBTI treatment, tailored for patients’ with CVD with a sleep improvement outcome. The findings also confirm that primary healthcare patients of older age living with CVD and insomnia, are interested in and able to use internet-based complex interventions to improve their sleep.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2022. , p. 97
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 113
Keywords [en]
Cardiovascular disease, insomnia, cognitive behavioral therapy, internet-based, utility, effect, patient experience, complex intervention
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-56213ISBN: 978-91-88669-12-4 (print)OAI: oai:DiVA.org:hj-56213DiVA, id: diva2:1652080
Public defence
2022-05-20, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2022-04-14 Created: 2022-04-14 Last updated: 2022-10-21Bibliographically approved
List of papers
1. Primary healthcare patients with cardiovascular disease eligible for nurse-led internet-based cognitive behavioral therapy for insomnia: characteristics and motives for participation
Open this publication in new window or tab >>Primary healthcare patients with cardiovascular disease eligible for nurse-led internet-based cognitive behavioral therapy for insomnia: characteristics and motives for participation
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(English)Manuscript (preprint) (Other academic)
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:hj:diva-56211 (URN)
Available from: 2022-04-14 Created: 2022-04-14 Last updated: 2022-10-21
2. Experiences and management of incidents that influence sleep in patients with cardiovascular disease and insomnia
Open this publication in new window or tab >>Experiences and management of incidents that influence sleep in patients with cardiovascular disease and insomnia
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2020 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 35, no 4, p. 364-374Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Insomnia is a global problem and an important risk factor for patients living with cardiovascular disease (CVD), causing poor well-being and worsening disease prognosis. Yet, there is a lack of effective intervention strategies targeting sleep problems. To deliver patient-centered interventions and achieve good quality of sleep for this group, the own experiences of patients with CVD need to be understood.

OBJECTIVE: The aim of this study was to describe experiences that influence the sleep situation and management of sleep problems among patients with CVD and insomnia.

METHOD: A qualitative descriptive design with critical incident technique methodology was used. Twenty patients (13 men and 7 women; mean age, 73 years; range, 47-83 years) with single or multiple verified CVD diagnoses and insomnia were included.

RESULTS: Four underlying categories of sleep disruptors were identified: cognitive, social, physical, and behavioral. Participants experienced distress from the heart condition at night, physically and cognitively, with high levels of concern about its consequences for themselves and their families. Participants' sleep management preferences and responses included cognitive, behavioral, and pharmacological management strategies. Participants preferred their own nonpharmacological insomnia management over professional advice.

CONCLUSION: Patients with CVD and insomnia experienced both physical and cognitive distress from their heart condition and chose to adopt nonpharmacological insomnia management. Tailored professional support is needed to change precipitating behavioral factors to be able to treat insomnia, improve sleep, reduce symptom burden, and enhance quality of life.

Place, publisher, year, edition, pages
Wolters Kluwer, 2020
Keywords
cardiovascular disease, critical incident technique, insomnia, qualitative research
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:hj:diva-50094 (URN)10.1097/JCN.0000000000000626 (DOI)000552074200012 ()31904689 (PubMedID)2-s2.0-85086524173 (Scopus ID)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, Sweden, FUTURUM-709691
Available from: 2020-07-17 Created: 2020-07-17 Last updated: 2022-04-14Bibliographically approved
3. The effect of nurse-led Internet-based cognitive behavioural therapy for insomnia on patients with cardiovascular disease: A randomized controlled trial with 6-month follow-up
Open this publication in new window or tab >>The effect of nurse-led Internet-based cognitive behavioural therapy for insomnia on patients with cardiovascular disease: A randomized controlled trial with 6-month follow-up
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2021 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 8, no 4, p. 1755-1768Article in journal (Refereed) Published
Abstract [en]

Aim: To test the effect of nurse-led Internet-based cognitive behavioural therapy for insomnia (I-CBTI), tailored for patients with cardiovascular disease (CVD), with a 6-month follow-up.

Design: A two-arm parallel-group randomized controlled trial (RCT) registered at clinicaltrials.gov (NTC03938805) and reported according to the CONSORT checklist.

Methods: Forty-eight patients (mean age 72 years, 65% men) diagnosed with CVD and insomnia were randomized to either 9-week nurse-led I-CBTI with support, or an Internet-based self-study programme without support (control group). Insomnia Severity Index (ISI) and Short Form Health Survey (SF-12) were used as primary and secondary outcomes.

Results: ISI showed a significant treatment effect of I-CBTI compared to the control group at 9-week follow-up. The mean ISI score in the I-CBTI group at 9 weeks post-treatment was maintained at the 6-month follow-up. Patients' adherence to I-CBTI was associated with a better effect on both the ISI and SF-12.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
cardiovascular disease, cognitive behavioural therapy, insomnia, internet-based, nurse support
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-51994 (URN)10.1002/nop2.817 (DOI)000619871700001 ()33609425 (PubMedID)2-s2.0-85101145473 (Scopus ID)GOA;;726168 (Local ID)GOA;;726168 (Archive number)GOA;;726168 (OAI)
Available from: 2021-03-08 Created: 2021-03-08 Last updated: 2022-04-14Bibliographically approved
4. The experience of a Nurse-led Internet-based Cognitive Behavioral Therapy for Insomnia on Patients with Cardiovascular Disease: A qualitative study
Open this publication in new window or tab >>The experience of a Nurse-led Internet-based Cognitive Behavioral Therapy for Insomnia on Patients with Cardiovascular Disease: A qualitative study
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(English)Manuscript (preprint) (Other academic)
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:hj:diva-56212 (URN)
Available from: 2022-04-14 Created: 2022-04-14 Last updated: 2022-10-21

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