Background Online interventions for insomnia can increase access to treatments for those with limited access to services. What remains unknown is whether individuals from more isolated (vs. more densely populated) regions engage with, and benefit as much from, an online intervention. This secondary analysis examined the relationship of geographical indices with engagement and outcomes of an efficacious, fully automated online cognitive behavioral therapy for insomnia (CBT—I) program (Sleep Healthy Using the Internet-SHUTi). Method 303 participants (Mage = 43.3; SD = 11.6) were randomly assigned to SHUTi or an online patient education condition and assessed at baseline and post intervention. Rural code of participants was determined using participant zip codes. Distance to the nearest sleep medicine provider was calculated as the distance between the center of the nearest provider's city (from a publicly available list of CBT-I providers) and the center of the participants' zip code. Adherence outcomes were number of intervention core completions, sleep diaries, and logins. Sleep outcomes were insomnia severity as well as sleep onset latency and wake after sleep onset derived from online sleep diaries. Results Individuals were from a range of geographic locations. Most lived in fairly densely populated areas; however, there was a large variation in distance to the nearest sleep medicine provider. Findings indicate that the efficacy, adherence, and engagement with SHUTi were not impacted by where people lived. Controlling for age and gender did not impact any of the relationships among geography variables (i.e., distance, ruralness) and adherence or sleep related outcomes. Conclusions Internet interventions must demonstrate that they can overcome obstacles posed by geography. This is the first study to examine the geographic location of participants and its association with engagement with, and outcomes of, online CBT-I.

中文翻译：

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在有效的互联网干预失眠的临床试验中，地理在参与和结果中的作用的二次分析

背景 失眠症的在线干预可以增加那些获得服务有限的人获得治疗的机会。仍然未知的是来自更孤立（相对于人口更密集）地区的个人是否参与在线干预并从中受益。该次要分析检查了地理指数与有效的、全自动的失眠在线认知行为疗法 (CBT-I) 计划（使用互联网健康睡眠-SHUTi）的参与度和结果之间的关系。方法 303 名参与者 (Mage = 43.3; SD = 11.6) 被随机分配到 SHUTi 或在线患者教育条件下，并在基线和干预后进行评估。使用参与者邮政编码确定参与者的农村代码。到最近的睡眠药物提供者的距离计算为最近提供者的城市中心（来自公开的 CBT-I 提供者列表）与参与者邮政编码中心之间的距离。依从性结果是干预核心完成次数、睡眠日记和登录次数。睡眠结果是来自在线睡眠日记的失眠严重程度以及入睡潜伏期和入睡后醒来。结果 个人来自不同的地理位置。大多数人居住在人口稠密的地区；然而，与最近的睡眠药物供应商的距离差异很大。研究结果表明，SHUTi 的功效、依从性和参与度不受人们居住地的影响。控制年龄和性别不影响地理变量（即距离、农村）和依从性或睡眠相关结果之间的任何关系。结论 互联网干预必须证明它们可以克服地理障碍。这是第一项研究参与者的地理位置及其与在线 CBT-I 的参与和结果的关系。