Hanati Mahelimuhan

School of Public Health, Shanghai Jiao Tong University,
China

Abstract Title:

Barriers, facilitators and techniques to improve sleep by cognitive behaviour therapy in older people: A mixed-methods systematic review

Biography:

Hanati Mahelimuhan is a fourth-year undergraduate student in Public Health at Shanghai Jiao Tong University, expected to graduate in 2027. Her research interest in older adults' sleep health stems from her work on community-based surveys of 24-hour movement behaviors. Under the supervision of her mentors, she has conducted this mixed-methods systematic review examining cognitive behavioral therapy for sleep improvement in older populations.

Research Interests:

Background Cognitive Behavioral Therapy (CBT) effectively improves sleep in older adults, yet adherence remains suboptimal due to poorly understood complex factors. Objectives: To identify barriers and facilitators influencing adherence to sleep-related CBT programs and the relevant behavior change techniques (BCTs) used among older adults. Methods: This mixed-methods systematic review searched six databases for studies on sleep-related CBT interventions among older adults from inception to May 2024. Barriers and facilitators were extracted, coded using the Theoretical Domain Framework (TDF), and mapped to the Capabilities, Opportunities, Motivations, and Behaviours (COM-B) model. Relevant BCTs were also extracted and categorized according to the Behavior Change Technique Taxonomy version 1 (BCTTv1). Results: Thirty studies were included, revealing 41 factors (23 barriers, 15 facilitators, three mixed) mapped to all COM-B dimensions and thirteen TDF domains. Motivation-related barriers were most frequently reported (21/30 studies) and constituted the largest category (9/23 barriers). Regarding facilitators, opportunity-related facilitators (3/15 facilitators) were reported most frequently (18/30 studies), while motivation-related facilitators formed the largest proportion (7/15 facilitators). Among the identified BCTs, fourteen out of 31 BCTs addressed capability-related determinants, with the most common being action planning and instruction on how to perform the behavior. Conclusion: This study provides a comprehensive synthesis of barriers, facilitators, and associated BCTs in CBT interventions for sleep improvement in older adults. A significant mismatch exists between the influencing factors and the BCTs used previously. While capability-related BCTs are overrepresented, motivation- and opportunity-related BCTs remain underutilized despite their prominence as key determinants of adherence.