Promoting sustained access to cognitive behavioral therapy for insomnia in Australia: a system-level implementation program

Study Objectives: Insomnia is a highly prevalent and debilitating disorder. Cognitive behavioral therapy for insomnia (CBTi) is the recommended “first line” treatment, but is accessed by a minority of people with insomnia. This paper describes a system-level implementation program to improve access to CBTi in Australia to inform CBTi implementation in other locations. 

Methods: From 2019–2023, we conducted a program of work to promote sustained change in access to CBTi in Australia. Three distinct phases included (1) scoping and mapping barriers to CBTi access, (2) analysis and synthesis of barriers and facilitators to devise change goals, and (3) structured promotion and coordination of change. We used a system-level approach, knowledge brokerage, and codesign, and drew on qualitative, quantitative, and implementation science methods. 

Results: We identified barriers to CBTi access from the perspectives of people with insomnia, primary care clinicians, and the health system. A stakeholder advisory committee was convened to codesign change goals, identify modifiable barriers, devise program logic, and drive change strategies. We commenced a program to promote system-level change in CBTi access via: improved awareness and education of insomnia among primary care clinicians, self-guided interventions, and advocating to Government for additional CBTi funding mechanisms. 

Conclusions: This implementation program made significant progress toward improving access to CBTi in Australia. Ongoing work is required to continue this program, as long-term system-level change requires significant and sustained time, effort, and resources from multiple stakeholders. This program may be used to inform CBTi implementation activities in other locations.