Why some embrace and others hesitate? A behavioral analysis of insomnia sufferers’ engagement with acupuncture treatment

BACKGROUND: Acupuncture is emerging as a promising treatment for insomnia. However, the determinants driving patients' decisions to pursue or adopt this treatment modality remain underexplored. AIM: To identify the key factors shaping the willingness of patients with insomnia to seek and engage in acupuncture from a patient-centered perspective. METHODS: A semi-structured focus group design was used, with a research framework integrating the capability, opportunity, motivation-behavior model, and theoretical domains framework. The results were mapped onto constructs of a behavioral wheel derived from the capability, opportunity, motivation-behavior/theoretical domains framework matrix. Data analyses employed abductive thematic analysis. RESULTS: Data saturation was achieved after ten focus group sessions, involving a total of 45 participants. Key facilitators for patients with insomnia seeking acupuncture included: (1) Cultural beliefs in ethnic medicine; (2) Concerns about the adverse effects of, and dependence on, hypnotics; (3) Expectations of improvement in comorbid symptoms; (4) Desire for more communication with the clinician; and (5) Incentives from peers and online key opinion leaders. Barriers were: (1) Limited knowledge of acupuncture indications; (2) Accessibility burden; (3) Needle-phobia; and (4) Safety concerns. Additionally, prior acupuncture experiences, family/friend attitudes, and treatment costs (reimbursement rate in health insurance) served as both facilitators and barriers. CONCLUSION: The interrelated facilitators and barriers underscore that the decision to use acupuncture for insomnia is a complex issue involving efficacy/safety, culture, economics, information dissemination, and communication factors. Expanding patient education on acupuncture, increasing media exposure, and improving governmental oversight of this process are essential. Investing in high-quality acupuncture services in public hospital nighttime clinics and community health centers is expected to address accessibility challenges. Acupuncturists need to improve doctor-patient communication, including guiding patients to set treatment expectations that are grounded in reality to enhance service quality. For patients with significant needle-phobia, cognitive manipulation or hypnosis techniques may be employed to improve treatment compliance.