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Barriers to insomnia treatment for general physicians in Iran: A mixed-method study
Abstract
Background: Insomnia is a common sleep disorder with adverse consequences on quality of life. Early diagnosis and treatment of insomnia can prevent these consequences. General physicians have an important role in the timely diagnosis and treatment of insomnia. Investigating the barriers that general physicians experience when treating insomnia may improve person-centered clinical care. The present study was designed to identify and analyze these barriers.
Methods: A mixed-methods design was used. General physicians who worked in Kermanshah, Iran, were recruited. Data collection methods included semi-structured interviews and questionnaires. Thematic analysis was used for qualitative data and quantitative data were analyzed using descriptive-analytic statistics.
Results: Barriers to insomnia treatment emerged from patient, physician and social domains. Beliefs about insomnia and concern about treatment were among the barriers in the patient category. Physicians’ attitude and insufficient knowledge of pharmacological and non-pharmacological treatment were common barriers in the physician category. Barriers related to socioeconomic problems and lack of awareness about sleep disorders. Social barriers interacted across domains. Physician reports generally did not differ based on years of work experience.
Conclusion: Barriers to insomnia treatment should be seen in light of the patient, physician and social system. These barriers do not operate in isolation, but interact and influence each other. Comprehensive programs to overcome barriers to insomnia treatment are recommended in the development of person-centered approaches to the management of insomnia.Keywords
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. 4th edn. Text revision. Washington, DC: American Psychiatric Association.
American Academy of Sleep Medicine. (2005). The international classification of sleep disorders: Diagnostic and coding manual. 2nd edn. Westchester, IL: American Academy of Sleep Medicine.
Ohayon, M.M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews 6, 97-111.
Castro, L.S., Poyares, D., Leger, D., Bittencourt, L. & Tufi, N S. (2013). Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study. Annals of Neurology 74, 537-546.
Shekleton, J.A., Rogers, N.L. & Rajaratnam, S.M. (2010). Searching for the daytime impairments of primary insomnia. Sleep Medicine Reviews 14, 47-60.
Katz, D.A. & McHorney, C.A. (2002). The relationship between insomnia and health-related quality of life in patients with chronic illness. Journal of Family Practice 51 (3) 229-236.
Pigeon, W.R. (2015). Diagnosis, prevalence, pathways, consequences & treatment of insomnia. Indian Journal of Medical Research 131, 321.
Khazaie, H., Rezaie, L., Tahmasian, M. & Schwebel, D.C. (2010). Insomnia treatment by olanzapine. Is sleep state misperception a psychotic disorder? Neurosciences 15, 110-112.
Khazaie, H. & Rezaie, L. (2015). Determination of consequences of chronic insomnia: A qualitative study. Scientific Journal of Kurdistan Medical University of Sciences 20 (4) 112-124.
Rezaie, L., Khazie, H. & Yazdani, F. (2016). Exploration of the experience of living with chronic insomnia: A qualitative study. Sleep Science 9 (3) 179-185.
Mousavi, F., Tavabi, A., Iran-Pour, E., Tabatabaei, R. & Golestan, B. (2012). Prevalence and associated factors of insomnia syndrome in the elderly residing in Kahrizak nursing home, Tehran, Iran. Iranian Journal of Public Health 41 (1) 96-106.
Morin, C.M., Bootzin, R.R., Buysse, D.J., Edinger, J.D., Espie, C.A. & Lichstein, K.L. (2006). Psychological and behavioral treatment of insomnia: An update of recent evidence (1998-2004). Sleep 29, 1396-1406.
Morin, C.M., Culbert, J.P. & Schwartz, S.M. (1994). Nonpharmacological Interventions for insomnia: A meta-analysis of treatment efficacy. American Journal of Psychiatry 151, 1172-1180.
Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C. & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine 4 (5) 487-504.
Qaseem, A., Kansagara, D., Forciea, M.A., Cooke, M. & Denberg, T.D. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 165 (2) 125-133.
Hajak, G. (2000). Insomnia in primary care. Sleep 23 (Supplement 3) S54-S63.
Namen, A.M., Landry, S.H., Case, L.D., McCall, W.V., Dunagan, D.P. & Haponik, E.F. (2001). Sleep histories are seldom documented on a general medical service. Southern Medical Journal 94, 874-879.
Cheung, J.M., Bartlett, D.J., Armour, C.L. & Saini, B. (2013). The insomnia patient perspective: A narrative review. Behavioral Sleep Medicine 11 (5) 369-389.
Rezaie, L. & Khazie, H. (2016). Barriers to the treatment of insomnia from patients' perspectives: A qualitative study. Scientific Journal of Kurdistan University of Medical Sciences 21 (5) 91-100.
Stinson, K., Tang, N.K. & Harvey, A.G. (2006). Barriers to treatment seeking in primary insomnia in the United Kingdom: A cross-sectional perspective. Sleep 29 (12) 1643-1646.
Benca, R.M. (2005). Diagnosis and treatment of chronic insomnia: A review. Psychiatric Services 56 (3) 332-343.
Dworkin, S.L. (2012). Sample size policy for qualitative studies using in-depth interviews. Archives of Sexual Behavior 41, 1319-1320.
Teddlie, C. & Tashakkori, A. (2003). Major issues and controversies in the use of mixed methods in the social and behavioral sciences. In: Handbook of mixed methods in the social and behavioral sciences. Tashakkori, A. & Teddlie, C. Eds. pp. 3-50. Thousand Oaks, CA: Sage.
Cresswell, J.W. & Plano Clark, V.L. (2007). Designing and conducting mixed method research. Thousand Oaks, CA: Sage.
Koskey, K. & Stewart, V. (2014). A concurrent mixed methods approach to examining the quantitative and qualitative meaningfulness of absolute magnitude estimation scales in survey research. Journal of Mixed Methods Research 8, 180-202.
Gill, P., Stewart, K., Treasure, E. & Chadwick, B. (2008). Methods of data collection in qualitative research: Interviews and focus groups. British Dental Journal 204 (6) 291-295.
Anthierens, S., Pasteels, I., Habraken, H., Steinberg, P., Declercq, T. & Christiaens, T. (2010). Barriers to non- pharmacologic treatments for stress, anxiety, and insomnia: Family physicians' attitudes toward benzodiazepine prescribing. Canadian Family Physician 56 (11) 398-406.
Cambell, J.L, Quincy, C., Osserman, J. & Pedersen, O.K. (2013). Coding in- depth semi structured interview: Problems of unitization and intercoder reliability and agreement. Sociological Method and Research 42 (3) 294-320.
Pope, C., Ziebland, S. & Mays, N. (2000). Qualitative research in health care: Analyzing qualitative data. British Medical Journal 320 (7227) 114-116.
Hewitt-Taylor, J. (2001). Use of constant comparative analysis in qualitative research. Nursing Standard 15 (42) 39-42.
Denzin, N.K. & Lincoln, Y.S. (2003). Strategies of qualitative inquiry. Thousand Oaks, CA: Sage.
Beck, C. (1993). Qualitative research: the evaluation of its credibility, fittingness, and auditability. Western Journal of Nursing Research 15 (2) 263-266.
Lichstein, K.L., Nau, S.D., Wilson, N.M., Aguillard, R.N., Lester, K.W., Bush, A.J. & McCrae, C.S. (2013). Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample. Behaviour Research and Therapy 51, 787-796.
Khazaie, H., Rezaie, L. & de Jong, D.M. (2013). Dropping out of outpatient psychiatric treatment: a preliminary report of a 2-year follow-up of 1500 psychiatric outpatients in Kermanshah, Iran. General Hospital Psychiatry 35 (3) 314-319.
Khazaie, H., Rezaie, L., Shahdipour, N. & Weaver, P. (2016). Exploration of the reasons for dropping out of psychotherapy: A qualitative study. Evaluation and Program Planning 56, 23-30.
DOI: http://dx.doi.org/10.5750/ejpch.v6i2.1442
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