1230 Social Determinants of Acceptability of Digital Therapeutics for Insomnia Among Hispanic Adults: Patient and Provider Perspectives

Abstract Introduction Self-guided digital health treatments represent an innovative means of addressing the increasing prevalence of insomnia among Hispanics. This study assessed how social determinants of health influence patient and provider perceptions of the acceptability of a digital cognitive behavioral therapy for insomnia (dCBTi) intervention adapted for Spanish-speaking populations. Methods This was a secondary analysis of a hybrid type 1 effectiveness-implementation study on barriers and facilitators to dCBTi implementation. Individual semi-structured interviews were conducted with 5 Spanish-speaking Hispanic patients with chronic insomnia and 9 healthcare providers from a large urban hospital system. Qualitative data were analyzed using thematic analysis and categorized using the National Institute on Minority Health and Health Disparities (NIMHD) interpretive framework. Results Patients were 49.8 years of age (± 12.3 years) on average and 100% female. Providers were 50.6 years old (± 9.2 years) on average, 22% male, and 78% female. Across domains of influence in the NIMHD framework, 20 themes were identified, 80% of which fell within the sociocultural environment domain. Patients more often described sociocultural factors at the community and society levels, emphasizing the impacts of mental health stigma and the influence of gender-role expectations shaped by marianismo (traditional feminine gender roles) on sleep. Patients also highlighted neighborhood noise, the broader public health burden of insomnia in the Hispanic community, and the limited knowledge of available mental health treatments. Providers primarily identified social determinants at the individual level, noting the influence of immigration status, language, educational attainment, and digital literacy on perceived patient suitability for digital therapeutics. Providers also described individual-level factors like lack of smartphone access, limited time, and housing instability as barriers to patient acceptability. Conclusion Factors related to the sociocultural environment shaped patient and provider perceptions of the acceptability for dCBTi for Hispanic populations. Successful implementation of dCBTi in the Hispanic community requires a more nuanced approach that accounts for the multiple levels and domains of social determinants shaping acceptability, particularly in relation to the sociocultural environment. Support (if any) This research was supported by the Agency for Healthcare Research and Quality under Award Number R01 HS242747.