Emotions, behavior, and cognition are the main factors contributing to insomnia. Insomnia not only affects sleep quality but also harms health, quality of life, and daytime functioning. Brief Behavioral Treatment for Insomnia (BBTI) is considered a short-term effective treatment for insomnia and has been implemented on online platforms. However, the causes of insomnia are complex, and when designing related digital products, it is essential to consider the psychological and lifestyle states of individuals with insomnia, employing a user-centered approach and interactive design. Previous research has integrated emotion tracking and an abdominal breathing game into the existing BBTI APP. This study will further incorporate the tracking of emotions and lifestyle factors (specifically diet and exercise) into a digital insomnia application, while also connecting with smartwatches and using the Experience Sampling Method (ESM) to collect data. It aims to explore the preferences of individuals with insomnia for digital tracking and examine the impact of their recorded information related to insomnia on their sleep and self-management. The ultimate goal of this study is to enhance the existing insomnia app's features, offering innovative and convenient self-monitoring methods to help therapists better understand the condition of individuals with insomnia, while improving self-awareness and self-management. The anticipated results are expected to provide design recommendations for future digital applications related to insomnia, thereby improving the digital healthcare experience and medical efficacy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
60
Reminder times will be personalized based on participants' lifestyle patterns. Participants will wear a smartwatch daily and use the app to record emotions, diet, exercise, and sleep during the two-week study.
Reminder times will be preset by the researchers. Participants will wear a smartwatch daily and use the app to record emotions, diet, exercise, and sleep during the two-week study.
National Taipei University of Technology
Taipei, Taipei, Taiwan
Changes in Insomnia Severity
Insomnia severity will be measured using the Insomnia Severity Index (ISI). The ISI consists of seven items, with each item rated from 0 to 4, resulting in a total score ranging from 0 to 28. Higher scores indicate greater insomnia severity. Changes in ISI scores will be used to evaluate whether the BBTI app intervention improves participants' insomnia symptoms.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Changes in Sleep Quality
Sleep quality will be measured using the Pittsburgh Sleep Quality Index (PSQI). The PSQI evaluates subjective sleep quality and sleep-related problems. Higher scores indicate poorer sleep quality. PSQI has 18 questions to evaluate sleep condition. The score range from 0-21, if score\>5 is associated with poor sleep. The higher score means poorer sleep quality.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Changes in Sleep parameters from sleep logs: sleep onset latency(SOL)
Sleep onset latency(SOL) is the time of duration from lying on bed to fall asleep. SOL shorter than 30 minutes is one of criteria of good sleep condition.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Changes in Sleep parameters from sleep logs: after sleep onset(WASO)
Wake after sleep onset(WASO) is the total time of wakefulness after sleep onset. WASO less than 30 minutes is one of criteria of good sleep condition.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Changes in Sleep parameters from sleep logs: total sleep time(TST)
Total sleep time(TST) is the total time of falling asleep. TST will be used to calculate sleep efficiency(SE).
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Changes in Sleep parameters from sleep logs: sleep efficiency(SE)
Sleep efficiency(SE) is the percentage of total sleep time to time in bed. A good sleep condition should meet the criteria of SE greater than 85%.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Changes in Emotional State: BBTI App self-record
Participants' emotional state will be measured through app-based self-reports and/or standardized emotional state questionnaires. Emotional records may include daily mood, stress, anxiety, or other sleep-related psychological states. Changes in emotional state will be used to examine whether lifestyle and sleep self-monitoring through the BBTI app is associated with emotional awareness and psychological well-being.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Changes in Emotional State: Profile of Mood States
The Profile of Mood States (POMS) is a self-administered questionnaire that measures mood through ratings of 65 emotion terms on a five-point scale. A Total Mood Disturbance (TMD) can be calculated by adding Tension, Depression, Anger, Fatigue and Confusion scores and then subtracting the Vigour score. TMD = (Tension + Depression + Anger + Fatigue + Confusion) - Vigour.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Response Rate for Sleep-Related Lifestyle Self-Monitoring
The response rate for sleep-related lifestyle self-monitoring will be assessed using app usage records from the BBTI app. Lifestyle self-monitoring entries include meal records, caffeinated beverage intake, and exercise records. This measure will be calculated as the percentage of lifestyle self-monitoring reminders followed by at least one completed relevant entry. Unit of Measure：Percentage of reminders followed by a completed entry (%)
Time frame: From Day 1 to Day 28 of the intervention period
Response Latency for Sleep-Related Lifestyle Self-Monitoring
Response latency for sleep-related lifestyle self-monitoring will be assessed using app usage records from the BBTI app. Lifestyle self-monitoring entries include meal records, caffeinated beverage intake, and exercise records. This measure will be calculated as the average time between the delivery of a lifestyle self-monitoring reminder and the completion of a relevant entry. Unit of Measure：Minutes
Time frame: From Day 1 to Day 28 of the intervention period
Overall Self-Monitoring Completion Rate Assessed by the BBTI App
Overall self-monitoring completion rate will be assessed using app usage records from the BBTI app. This measure will be calculated as the percentage of scheduled daily self-monitoring tasks completed by participants, including sleep, emotion, diet, and exercise entries. Unit of Measure：Percentage of scheduled self-monitoring tasks completed (%)
Time frame: From Day 1 to Day 28 of the intervention period
Difference in Overall Self-Monitoring Completion Rate Between Personalized and Non-Personalized ESM Reminder Groups
The difference in overall self-monitoring completion rate between the personalized ESM reminder group and the non-personalized ESM reminder group will be assessed using app usage records from the BBTI app. Overall self-monitoring completion rate will be calculated as the percentage of scheduled self-monitoring tasks completed by participants, including sleep, emotion, diet, and exercise entries. The personalized ESM reminder group will receive reminders based on individual lifestyle patterns, while the non-personalized ESM reminder group will receive reminders at fixed times. Unit of Measure：Difference in percentage of scheduled self-monitoring tasks completed between groups (%)
Time frame: From Day 1 to Day 28 of the intervention period
Changes in Sleep-Related Lifestyle Behaviors: BBTI App Self-Record
Participants' sleep-related lifestyle behaviors will be measured through app-based self-records in the BBTI app. Lifestyle records will include meal timing and perceived fullness, caffeinated beverage intake time and amount, and exercise timing and exercise amount. Changes in sleep-related lifestyle behaviors will be used to examine participants' self-monitoring patterns and changes in lifestyle behaviors during the intervention.
Time frame: From Day 1 to Day 28 of the intervention period
Changes in Perceived Capability, Opportunity, and Motivation for Lifestyle Self-Monitoring
Participants' perceived capability, opportunity, and motivation for insomnia-related lifestyle self-monitoring will be assessed using a COM-B-based self-report questionnaire. The questionnaire will evaluate participants' perceived capability to record lifestyle behaviors, perceived opportunity to perform self-monitoring, and motivation to continue tracking sleep-related lifestyle factors. The change score will be calculated as the difference between baseline and post-intervention questionnaire scores. Unit of Measure：Change in mean questionnaire score
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Change in Insomnia-Related Lifestyle Knowledge, Attitudes, and Behaviors
Insomnia-related lifestyle knowledge, attitudes, and behaviors will be assessed using a self-report questionnaire. The questionnaire will evaluate participants' knowledge of sleep-related lifestyle factors, attitudes toward lifestyle self-monitoring and behavior change, and self-reported lifestyle behaviors related to insomnia management. The change score will be calculated as the difference between baseline and post-intervention questionnaire scores. Unit of Measure：Change in mean questionnaire score
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Brief Symptom Rating Scale-5 (BSRS-5)
The BSRS-5 asks patients to reflect on the past week (including the assessment day) and rate their level of distress or discomfort. A total score of ≤3 indicates low suicide risk. It uses a 5-point Likert scale and contains 6 items.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
WHO-5 Well-Being Index
The WHO-5 measures subjective mental well-being and quality of life over the past two weeks using 5 items on a 6-point Likert scale. Scoring: Raw scores range from 0-25, with higher scores indicating better well-being. Multiply the raw score by 4 to obtain a percentage score (0-100). Interpretation: Further assessment for major depression (ICD-10) is recommended if the raw score is below 13 or if any item is rated 0 or 1.
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Rating Scale of Mental Effort in App Use Experience
The RSME measures the level of mental effort experienced while performing a task. Scores range from 0 to 150, with higher scores indicating greater mental effort.
Time frame: at baseline, Week 2, and Week 4, participants completed the in-app assessment before the task and after completing the intervention.
Average Sleep Score Collected by Smartwatch
Average sleep score will be assessed using sleep data collected by a smartwatch. This measure will be calculated as the average nightly sleep score during the intervention period. Unit of Measure：Sleep score
Time frame: From Day 1 to Day 28 of the intervention period
Average Daily Step Count Collected by Smartwatch
Average daily step count will be assessed using physical activity data collected by a smartwatch. This measure will be calculated as the average number of steps per day during the intervention period. Unit of Measure：Steps per day
Time frame: From Day 1 to Day 28 of the intervention period
Average Active Energy Expenditure Collected by Smartwatch
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Average active energy expenditure will be assessed using physical activity data collected by a smartwatch. This measure will be calculated as the average active energy expenditure per day during the intervention period. Unit of Measure：Kilocalories per day
Time frame: From Day 1 to Day 28 of the intervention period
Average Heart Rate Collected by Smartwatch
Average heart rate will be assessed using physiological data collected by a smartwatch. This measure will be calculated as the average heart rate during the intervention period. Unit of Measure：Beats per minute
Time frame: From Day 1 to Day 28 of the intervention period
Average Heart Rate Variability Collected by Smartwatch
Average heart rate variability will be assessed using physiological data collected by a smartwatch. This measure will be calculated as the average heart rate variability during the intervention period. Unit of Measure：Milliseconds
Time frame: From Day 1 to Day 28 of the intervention period
System Usability Assessed by the System Usability Scale
System usability will be assessed using the System Usability Scale after the 4-week intervention. The scale will evaluate participants' subjective perceptions of system usability, learnability, and overall satisfaction with the BBTI app and self-monitoring system. Unit of Measure：System Usability Scale score
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
User Experience of the BBTI App: User Experience Questionnaire
Participants' user experience of the BBTI app will be assessed using the User Experience Questionnaire (UEQ). The questionnaire will evaluate participants' perceptions of the app across user experience dimensions, such as attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty. The UEQ score will be used to assess participants' subjective experience of using the BBTI app and smartwatch-supported lifestyle self-monitoring system. Unit of Measure：UEQ mean scale score
Time frame: at baseline, Week 2, and Week 4, immediately after completion of the intervention.
Cognitive Load During Usability Testing Assessed by NASA-TLX
Cognitive load during usability testing will be assessed using the NASA Task Load Index (NASA-TLX). Participants will complete the NASA-TLX after operating the prototype. The scale will assess perceived workload, including mental demand, physical demand, temporal demand, performance, effort, and frustration. Unit of Measure：NASA-TLX score
Time frame: During usability testing, Day 1
Attention Level During Prototype Operation Assessed by EEG
Attention level during prototype operation will be assessed using an electroencephalography device during usability testing. The measure will be calculated based on the attention index or attention-related EEG indicator recorded while participants operate the prototype.
Time frame: During usability testing, Day 1
Heart Rate Variability During Usability Testing
Heart rate variability during usability testing will be assessed using physiological data collected while participants operate the prototype. This measure will be calculated as the average heart rate variability during prototype operation. Unit of Measure：Milliseconds
Time frame: During usability testing, Day 1
Insight Formation Ability During Lifestyle Data Visualization Review
Insight formation ability will be assessed during usability testing based on participants' responses while reviewing lifestyle data visualizations. The analysis will refer to North's insight-based evaluation approach to evaluate the degree to which participants generate meaningful insights from lifestyle data charts. Unit of Measure：Insight formation score
Time frame: During usability testing, Day 1