Development of a voice-activated virtual assistant to improve insomnia among young adult cancer survivors: Focus groups findings and device feasibility testing (Preprint)

BACKGROUND Up to 75% of young adult cancer survivors (YACS) experience chronic insomnia, negatively affecting physical and emotional health and overall quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard intervention to address insomnia. However, widespread uptake of CBT-I remains limited and new strategies of CBT-I delivery are warranted. OBJECTIVE We wished to understand how YACS experience insomnia, how they might incorporate technology-delivered CBT-I into a daily routine and test the feasibility and acceptability of a novel voice-activated virtual assistant-delivered CBT-I prototype. METHODS We conducted four focus groups (6-7 participants per group, N=26 total) to understand the YACS experience of insomnia, their routine use of technology at home, particularly voice-activated virtual assistants such as the Amazon Alexa, and input on how CBT-I might be delivered at home through a smart speaker system. We developed a prototype device to deliver key elements of CBT-I at home along with circadian lighting and monitoring of post-bedtime device use, collected YACS user perspectives on this prototype, and then conducted a single-arm feasibility and acceptability study. RESULTS Twenty-six YACS experiencing insomnia participated in focus groups to share experiences of insomnia during cancer survivorship and to provide input regarding a CBT-I prototype. Common triggers of insomnia included worry about disease management and progression, disease-related pain and other symptoms, choices regarding personal device use, and worry about the impact of poor sleep on daily functioning. Twelve participants completed device prototype testing, exceeding pre-determined feasibility and acceptability benchmarks and providing qualitative data to inform future device refinement. CONCLUSIONS YACS were highly engaged with our voice-activated virtual assistant-delivered CBT-I prototype and found it acceptable to use. Following final device development, future studies should evaluate efficacy of this intervention among YACS. CLINICALTRIAL NCT05875129