Clinician and patient barriers to the recognition of insomnia in family practice: a narrative summary of reported literature analysed using the theoretical domains framework

Abstract

Background: Insomnia is a common sleep complaint, with 10% of adults in the general population experiencing insomnia disorder, defined as lasting longer than three months in DSM-5. Up to 50% of patients attending family practice experience insomnia, however despite this, symptoms of insomnia are not often screened for, or discussed within this setting. We aimed to examine barriers to the assessment and diagnosis of insomnia in family practice from both the clinician and patient perspective. Methods: The present article identified research that has examined barriers to assessing insomnia from the clinician's and the client's perspectives following MEDLINE and Google Scholar searches, and then classified these barriers using the theoretical domains framework. Results: The most common barriers from the clinician's perspective were related to Knowledge, Skills, and the Environmental Context. From the patient perspective, barriers identified included their Beliefs about the consequences of Insomnia, Social Influences, and Behavioural Regulation of Symptoms. Conclusions: Utilising this theoretical framework, we discuss options for bridging the gap between the identification and subsequent management of insomnia within the family practice setting. To assist clinicians and those in community health care to overcome the Knowledge and Skills barriers identified, this article provides existing relevant clinical criteria that can be utilised to make a valid diagnosis of insomnia.

Reaching everyone in general practice? Feasibility of an integrated domestic violence training and support intervention in primary care

“…The equivalent ratio was 42–58% in Practice B, and 67–33% in Practice A. The absence of training and guidance about how to record and respond to third party information [ 39 , 49 ] contributed to a lack of clarity about expectations and responsibility for action when information about DVA was shared between agencies (Fig. 1 .…”

“…The analysis of EMR and our sub-study on DVA information sharing [ 39 ] both suggest that the notification about DVA from third parties received by GPs has the potential to contribute to better treatment and safeguarding plans of vulnerable patients. Incorporating information received from other agencies into the EMR and using it to inform patient care in the consultation, however, requires careful professional judgement.…”

“…The multidisciplinary research team integrated diverse evidence sources into the development of the IRIS+ training and support intervention. These included (i) a systematic review and thematic synthesis of qualitative studies [ 25 ], and (ii) an integrated mixed method analysis of systematic review evidence of help-seeking by male victims of DVA [Huntley et al, Help seeking by male victims of domestic violence and abuse: an integrated mixed method analysis of systematic review evidence, accepted]; (iii) a mapping study of UK services for male victims; (iv) a two-stage consensus process with a multi-professional stakeholder group including experts of DVA and health; (v) and a qualitative sub-study with general practice clinicians and police staff about information sharing [ 39 ]. The design of the intervention was also informed by previous research evidence [ 20 , 36 , 40 ], particularly our study of prevalence of DVA in male general practice populations [ 16 ], a systematic review on interventions aimed to professionals working with children exposed to DVA [ 41 ], as well as our systematic reviews of DVA and mental health [ 42 , 43 ].…”

“…Given the well established evidence on the feasibility and effectiveness of IRIS to female survivors [ 20 – 22 ], this paper primarily focuses on the implications of the IRIS+ feasibility findings to men and children. Detailed findings of individual evidence streams [ 25 , Huntley et al, Help seeking by male victims of domestic violence and abuse: an integrated mixed method analysis of systematic review evidence, accepted] specific, areas of investigation [Roy et al, ‘It felt like there was always someone there for us’: supporting children affected by domestic violence and abuse in general practice, under review] and findings of an associated sub-study [ 39 ] are reported elsewhere.…”

Change of Willingness to Accept COVID-19 Vaccine and Reasons of Vaccine Hesitancy of Working People at Different Waves of Local Epidemic in Hong Kong, China: Repeated Cross-Sectional Surveys

“…Considering all this, information dissemination efforts on safety of the vaccination, which are as important as efficacy and effectiveness of the vaccine, should be enhanced by health authorities and organizations, particularly through online social media where the issue of misinformation is severe [ 35 , 36 , 40 ]. The primary care sector should also be engaged in health education to increase vaccination coverage [ 41 ]. For the information dissemination, there should not only be information about the safety of the vaccination but also messages conveying that vaccination is a part of the individual infection control precautions that would complement social distancing and handwashing in disease prevention, and could be helpful to both individuals and communities to resume normal life.…”