Influence of Stepped Support on Older Adults’ Internet Insomnia Intervention Engagement and Outcomes

Background: While delivering care by the Internet holds substantial potential to increase access to behavioral insomnia treatment, sustaining user engagement is considered a challenge. Minimal human support may enhance intervention engagement and efficacy, and older adults may particularly benefit from additional support for otherwise self-directed Internet interventions.Objectives: Test whether a human-delivered stepped support protocol improves engagement and outcomes using a fully-automated cognitive-behavioral therapy for insomnia program tailored for older adults (Sleep Healthy Using the Internet-Older Adult Sufferers of Insomnia and Sleeplessness [SHUTi-OASIS]).Methods: Adults aged 55 and older with insomnia (N=207) were randomized to receive SHUTi-OASIS alone or with stepped support (SHUTi-OASIS+SS). SS could be activated at intervention Core 1 or Core 2 (of six total Cores) if a participant had not completed the Core within two weeks of it becoming available. Engagement metrics were tracked by the Internet intervention platform. Participants self-reported insomnia outcomes by survey and prospective online sleep diaries at baseline, post-9 week intervention period, post 6-months, and post 12-months. Results: There was minimal activation of stepped support (14 of 102 SHUTi-OASIS+SS participants). There were no consistent differences in engagement or insomnia outcomes found when comparing SHUTi-OASIS versus SHUTi-OASIS+SS participants, nor when comparing only low-engaging participants across each condition (n=15 SHUTi-OASIS versus n=14 SHUTi-OASIS+SS).Conclusions: In this trial, most older adults engaged with the Internet intervention as instructed without the need for human support. Findings highlight the utility of highly-engaging Internet interventions for addressing older adults’ healthcare needs.