The acceptability of digital cognitive behavioural therapy for insomnia interventions: A mixed methods systematic review

Digital cognitive behavioural therapy for insomnia (dCBT-I) is a promising solution to the widely recognised lack of access to CBT-I treatments. Although dCBT-I has been found to be effective, it is unclear how acceptable it is by recipients. This mixed-methods systematic review aimed to explore the acceptability of dCBT-I interventions by integrating a range of acceptability data from across quantitative, qualitative and mixed-methods studies. PsycINFO, EMBASE, MEDLINE, CINAHL Plus and CENTRAL were systematically searched, yielding 2347 unique citations from which 68 studies were included in the review. Thirty-three studies only reported proxy measures of acceptability, the results of which were extremely varied across studies. Six interrelated themes were identified from acceptability data extracted from the remaining 35 studies, derived from n = 2497 participants: general acceptability, perceived helpfulness, individualised needs, congruence with personal life, functionality, and design. There was a trend towards acceptability across several of the identified themes with evidence showing that dCBT-I interventions are not always congruent with recipients' personal experiences nor allow for tailoring to their individualised needs. Methodological issues with the way acceptability is defined and measured in the literature suggests that improvements are needed to future research design before we can be confident in these findings.