4 - (OP29) Nurse-supported Mobile App for Self-help Cognitive Behavioral Therapy for Insomnia in Informal Cancer Caregivers: A Mixed-method Feasibility Study

Abstract
Background
Insomnia is highly prevalent among informal cancer caregivers; however, access to therapist-led cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment, remains limited. Although mobile and self-help CBT-I interventions may improve accessibility, adherence and engagement remain challenging. To address this gap, this study examined the feasibility and preliminary effects of a nurse-supported mobile app delivering self-help CBT-I for cancer caregivers.

Methods
Adult informal cancer caregivers with insomnia symptoms were recruited from a tertiary cancer hospital in Shanghai, China. Participants enrolled in a 6-week self-help CBT-I program delivered via a WeChat mini program (WMP), complemented by weekly nurse-support sessions. Feasibility outcomes included recruitment, retention, adherence, safety (adverse events), and acceptability. Preliminary outcomes—insomnia severity, sleep parameters, fatigue, anxiety, depression, quality of life, and caregiver burden—were assessed at baseline and post-intervention. Semi-structured qualitative interviews were conducted with all participants and analyzed using content analysis.

Results
A total of 12 participants were recruited. Recruitment, retention, and adherence all exceeded predefined thresholds, with rates of 80% for recruitment, 100% for retention, 97% for WMP-based CBT-I sessions, 96% for sleep diaries, and 92% for nurse-support sessions. No adverse events were reported. The mean revised Acceptability E-scale score was 36.2 (95% CI: 34.6–37.7), indicating high acceptability. Preliminary pre–post analyses demonstrated significant improvements in insomnia severity (d = -1.82, 95% CI [-2.74, -0.86], p < .001), sleep efficiency (d = 0.90, 95% CI [0.21, 1.57], p = .010), sleep onset latency (d = -0.68, 95% CI [-1.30, -0.04], p = .038), wake after sleep onset (d = -0.97, 95% CI [-1.65, -0.27], p = .003), and Pittsburgh Sleep Quality Index (d =-1.20, 95% CI [-1.93, -0.43], p = .002). No significant changes were observed in other outcomes. Qualitative findings further supported feasibility, with participants reporting that the WMP was easy to use and accessible, valuing nurse-support sessions for enhancing motivation and adherence, and suggesting minor refinements (e.g., simplifying sleep diary input) to improve usability.

Conclusions
The nurse-supported mobile app delivering self-help CBT-I was feasible, safe, and acceptable among informal cancer caregivers with insomnia symptoms. These findings provide preliminary support for progressing to a fully powered randomized controlled trial.