Abstract
AIMS: To determine the treatment effectiveness associated with mobile health-delivered cognitive behavioural therapy for insomnia (mCBT-I) interventions for adults with insomnia and to identify the potential characteristics associated with better treatment outcomes. DESIGN: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. METHODS: Seven English- and two Chinese-language databases were searched, without restrictions on publication dates, up to July 2024. Reference lists of relevant reviews and grey literature were included in the search. Randomised controlled trials evaluating mCBT-I in adults with insomnia and published in either English or Chinese were included in this meta-analysis. A random-effects model was used for data analysis, accompanied by additional subgroup analyses and meta-regression. RESULTS: Sixteen studies involving 2146 participants were included in this meta-analysis. mCBT-I interventions were associated with significantly reduced insomnia symptoms and improved sleep quality at post intervention, at 1-3-month follow-up, and at 4-6-month follow-up. Interventions that included five components of CBT-I, were delivered for 6 weeks or longer, and were conducted in a group format were linked to better treatment outcomes; the differences in other subgroup categories were not statistically significant. Studies involving participants with comorbid conditions showed a greater effect in reducing insomnia symptoms than those without such participants. In addition, mCBT-I interventions delivered by healthcare professionals resulted in statistically larger effect sizes for improving sleep quality than self-help regimens. CONCLUSIONS: The systematic review and meta-analysis identified the effectiveness of mCBT-I in reducing insomnia symptoms and improving sleep quality and offered practical implications for the development of effective mCBT-I interventions in clinical practice. However, future robust studies are needed to explore the long-term effects of mCBT-I interventions. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. TRAIL REGISTRATION: PROSPERO CRD: 42023454647.