Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for chronic insomnia, yet few receive this standard of care, and those from marginalized groups suffer a disproportionate impact. While digital CBT-I (dCBTi) shows promise in addressing access disparities, the specific barriers and facilitators for the successful implementation of digital therapeutics for those with limited English proficiency is unknown. Our aim was to identify the implementation determinants of dCBTi, overall, and for Hispanic adults. Methods We conducted 25 semi-structured virtual interviews with 5 Spanish-speaking Hispanic patients with chronic insomnia, 9 healthcare providers from a large urban hospital, and 11 content experts/leaders (local/national hospital administrators, community and business leaders, sleep advocates, health navigators, clinical psychologists, and representatives from digital therapeutics advocacy groups and government agencies). Interviews were audio-recorded and transcribed. Data were analyzed using thematic analysis and categorized using the Consolidated Framework for Implementation Research. Results Patients (Mage=49.8 SD=12.3) were middle-aged Hispanic women from Mexico, Cuba, or the Dominican Republic. Providers (Mage=50.6 SD=9.2), and content experts/leaders (Mage=47.7 SD=4.8) were majority women, non-Hispanic White, and 80% had worked with their organization for over 5 years. Over 90% of the themes identified pertained to perceived determinants of digital therapeutics uptake related to the innovation (source, evidence-base, relative advantage, adaptability, trialability, complexity, design), and individuals’ domain (concerns about the capability, opportunity, need or motivation of digital therapeutic recipients or deliverers), which were raised by all stakeholder groups. Content experts and leaders were the only stakeholder group to identify themes focused on outer setting determinants (local attitudes, policies and laws, financing, external pressure). Patients and providers indicated that the inclusion of third-party support (i.e., additional social and navigation support) will be an essential implementation process strategy to engage digital therapeutic recipients. Content experts/leaders and providers also emphasized inner setting determinants such as integrating the digital therapeutics within their existing work-infrastructure (i.e., electronic health record). Conclusion Our analysis of stakeholders’ perspectives suggests that increasing the uptake of dCBTi in underserved populations will require coordinated, multi-level implementation strategies that address multiple barriers at the policy, organizational, individual, and the digital therapeutic design level. Support (if any) HS242747
Alcántara et al. (Fri,) studied this question.