OPTIMIZATION OF WEB-BASED COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA NITECAPP IN RURAL DEMENTIA CAREGIVERS

Abstract Informal dementia caregivers (CGs) often experience chronic insomnia that contributes to stress and poor health. Rural CGs are particularly vulnerable but have limited access to CBT for insomnia (CBT-I), a recommended treatment for chronic insomnia. Web delivery holds promise for improving outcomes and access to this frontline treatment. Here we describe the iterative development of web CBT-I for rural dementia CGs. Qualitative and quantitative evaluations were conducted to explore user needs and adapt/validate content using a stepwise approach: 1- advisory panel of rural CGs (n=5) and primary care providers (PCPs; n=5) gave feedback used to adapt NiteCAPP, 2-focus groups of CGs (n=5) and PCPs (n=7) reviewed the newly adapted intervention and gave additional feedback, 3-NiteCAPP CARES was piloted in CGs (n=5) to test feasibility and establish preliminary effects. Fourteen daily electronic sleep diaries and questionnaires assessing arousal, health, mood, burden, subjective cognition, and interpersonal processes were collected pre/post treatment. Feedback recommended streamlining content, eliminating jargon, and including CG focused content. Multiple features were evaluated positively (comprehensive and engaging information, CG focus, layout, easy-to-access material, easy-to-understand sleep graphs). Suggestions for improvement included giving day/night viewing options, collapsible text, font size options, tabbed video access, and a glossary. Preliminary effects on CG sleep, arousal, health, mood, burden, cognition, and interpersonal processes (ps<.05) were promising. Targeted web CBT-I may increase access and improve CG outcomes. NiteCAPP CARES is now being evaluated in NIA-funded RCT.