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Enhancing digital CBT-I to improve adherence and reduce disparities

Award Number: R01HL159180
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/20/2021
PERIOD OF PERFORMANCE END DATE: 05/31/2026
AWARD TERMINATION DATE: 03/12/2026

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Enhancing digital CBT-I to improve adherence and reduce disparities - PROJECT SUMMARY/ABSTRACT Insomnia is a debilitating condition that escalates risk of a myriad of disorders, and affects up to one third of adults. Although insomnia can be effectively treated with Cognitive Behavioral Therapy for Insomnia (CBT-I), there is a shortage of specialty providers trained in CBT-I. Consequently, most patients with insomnia are unable to receive CBT-I as the recommended first-line intervention for insomnia. To address this problem, CBT-I can now be delivered digitally (dCBT-I) with strong efficacy; however, the real-world effectiveness of dCBT-I is limited by poor engagement. Over 50% of patients do not complete the full course of dCBT-I, and 40% of those who persist in treatment do not adhere to critical components of dCBT-I. Moreover, treatment completion and adherence are 2-3 times worse in those with low socioeconomic status. Our pilot data indicate that the disparity in completion and adherence to dCBT-I is related to low health literacy, defined as the ability to find, understand, and use information and services to inform health-related decisions. Health literacy is especially critical for engagement with digital interventions that are self-guided, such as dCBT-I. This proposal responds to an announcement focused on improving patient adherence to treatments. We propose a large-scale intervention comparing enhanced dCBT-I to control dCBT-I in improving treatment completion and adherence in a sample stratified by socioeconomic status. We also propose to test the effect of enhanced dCBT-I on reducing socioeconomic disparities in treatment adherence and completion. An innovative component of this trial is the use of non-specialist coaches as a scaffold for low health literacy, and to enhance treatment motivation and self-efficacy. Furthermore, those who are at-risk for treatment non- completion are shifted to telehealth coaching focused on one single critical behavioral component tailored for ease of assimilation into the patient’s daily life. The adaptive component provides patients two different treatment modalities to maximize engagement and both approaches leverage technology to increase accessibility. Our long-term goal is to ensure equitable effectiveness of digital insomnia treatments. To that end, our overall objective is to determine how adherence and completion in dCBT-I can be improved, particularly in those with low SES as a health disparities population. Based on pilot data, our central hypothesis is that, compared to control dCBT-I, enhanced dCBT-I will increase engagement by providing targeted support for those who need it.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2025	HENRY FORD HEALTH SYSTEM	1 FORD PL # 5B	DETROIT	MI	48202	WAYNE	USA	National Center on Sleep Disorders Research	000	5	3/12/2026	TERMINATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = $522,321 )
2025	2025	HENRY FORD HEALTH SYSTEM	1 FORD PL	DETROIT	MI	48202	WAYNE	USA	National Center on Sleep Disorders Research	000	5	8/25/2025	NON-COMPETING CONTINUATION	$522,321
														Subtotal = $522,321

Issue Date FY: 2024 ( Subtotal = $573,731 )
2024	2024	HENRY FORD HEALTH SYSTEM	1 FORD PL	DETROIT	MI	48202	WAYNE	USA	National Center on Sleep Disorders Research	000	4	8/27/2024	NON-COMPETING CONTINUATION	$573,731
														Subtotal = $573,731

Issue Date FY: 2023 ( Subtotal = $641,631 )
2023	2023	HENRY FORD HEALTH SYSTEM	1 FORD PL	DETROIT	MI	48202	WAYNE	USA	National Center on Sleep Disorders Research	001	3	8/24/2023	NON-COMPETING CONTINUATION	$641,631
2023	2022	HENRY FORD HEALTH SYSTEM	1 FORD PL	DETROIT	MI	48202	WAYNE	USA	National Center on Sleep Disorders Research	000	2	4/3/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $641,631

Issue Date FY: 2022 ( Subtotal = $641,887 )
2022	2022	HENRY FORD HEALTH SYSTEM	1 FORD PL	DETROIT	MI	48202	WAYNE	USA	National Center on Sleep Disorders Research	000	2	8/18/2022	NON-COMPETING CONTINUATION	$641,887
														Subtotal = $641,887

Issue Date FY: 2021 ( Subtotal = $644,343 )
2021	2021	HENRY FORD HEALTH SYSTEM	1 FORD PLACE	DETROIT	MI	48202	WAYNE	USA	National Center on Sleep Disorders Research	000	1	9/20/2021	NEW	$644,343
														Subtotal = $644,343

Grand Total All Awards = $3,023,913

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Enhancing digital CBT-I to improve adherence and reduce disparities

Award Number: R01HL159180

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/20/2021

PERIOD OF PERFORMANCE END DATE: 05/31/2026

AWARD TERMINATION DATE: 03/12/2026

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