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Abstract Introduction Chronic insomnia significantly affects health, functioning, and quality of life for many Veterans, yet access to evidence-based behavioral insomnia care remains limited. This Hybrid III stepped-wedge trial aims to test the implementation and treatment effectiveness of delivering Brief Behavioral Treatment for Insomnia (BBTI) into the VA Primary Care Mental Health Integration (PCMHI) setting. Methods Enrolled clinicians, across the four sites (n=16) were interviewed after the 12-month implementation phase. The semi-structured qualitative interview focused on clinician experiences during the implementation phase, how access to the bundle of implementation strategies influenced their delivery of BBTI in PCMHI, specific strategies that were most or least helpful, and barriers that impeded implementation efforts. Interviews were transcribed and summarized using rapid qualitative analysis. Interview data was synthesized and organized into a template based on applicable Expert Recommendations for Implementing Change (ERIC) strategies. Results Participating clinicians rated BBTI as highly compatible in PCMHI settings, adaptable in its delivery, and an important intervention for meeting Veterans’ needs. Clinicians felt supported during the implementation of BBTI through access to a variety of educational resources. The most frequently cited barrier to implementation was work infrastructure difficulties, including high caseloads and inadequate staffing. Another common barrier was Veterans’ co-morbid diagnoses and other health issues taking precedence over insomnia care. Lastly, multiple sites struggled to engage primary care, and other referring, providers. To facilitate sustainable delivery of BBTI in the future, clinicians requested continued access to BBTI resources and education materials and recommended ongoing group discussion and consultation amongst PCMHI clinicians. Conclusion Clinicians rated BBTI as a high-quality intervention with high mission alignment and were eager to continue providing BBTI after the study’s conclusion, despite implementation barriers. When integrated with implementation outcomes (i.e., reach, effectiveness, adoption, implementation, maintenance), front-line clinician perspectives and feedback can support efforts to foster sustainable delivery of BBTI and can inform a larger-scale rollout of BBTI into the VA PCMHI setting. Support (if any) VA Health Services Research and Development (I01 HX003096; PI Bramoweth)
Hough et al. (Sat,) studied this question.