Authors (Year) [Ref] | Country (community/cohort) | Study population | Measures | Main findings | TDF Domain(s) |
---|---|---|---|---|---|
Orr et al. (1980) [37] | United States | 378 Physicians attending a course on sleep disorders | Examination of popular misconceptions of sleep (20 Questions) | Physicians scored below chance suggesting a greater need for sleep medicine education as part of training. | Skills |
Hohagen et al. (1993) [38] | Germany | 2512 patients attending 10 general practitioners | Questionnaire at 3 time points: baseline (T1), 4 months later (T2), 2-years later (T3), included DSM criteria | In 8.8% of cases of mild insomnia, 21.9% of cases of moderate insomnia and 39.2% of cases of severe insomnia the GP was aware of a sleep problem. 5% of insomnia cases were diagnosed without the patient reporting a sleep problem in the questionnaire. | Knowledge, Skills |
Hohagen et al. (1994) [39] | Germany | 330 older adults (aged 65+) attending 5 general practitioner clinics | DSM-III-R criteria | In 18% of cases of mild insomnia, 31% of cases of moderate insomnia and in 52% of cases of severe insomnia the GP was aware of a sleep problem. 14% of insomnia cases were diagnosed without the patient reporting a sleep problem in the questionnaire. | Knowledge, Skills |
Haponik et al. (1996) [40] | United States | 20 experienced primary care practitioners, 23 uninstructed medical interns and 22 interns with instruction on sleep medicine | Frequency of sleep history recorded during encounters with simulated patients (30 min consultations) | Interns who had received instruction in sleep medicine more often asked about sleep (81.8%), but uninstructed interns (13%) and physicians (0%) did not record sleep history during consultation. | Knowledge, Belief about capability |
Papp et al. (2002) [41] | United States (Northeast Ohio) | 105 physicians | Structured survey on attitudes and knowledge of sleep disorders | Physicians rated their knowledge of sleep disorders as ‘fair’ (60%) and ‘poor’ (30%). Only 10% rated their knowledge as good, and 0% rated it as excellent. | Knowledge, Skills, Professional Role and Identity, |
Greatest influence on changing practice style regarding sleep were journal articles followed by continuing education, followed by discussion with specialists. | |||||
Siriwardena et al. (2010) [42] | United Kingdom (Lincolnshire, rural cohort) | Cross-sectional study of GPs (n = 84) | Prescribing preferences of GPs for insomnia vs anxiety diagnoses | For insomnia, GPs were more likely to favour giving advice on sleep hygiene and prescribing a hypnotic (Z-drugs favoured over benzodiazepines). For anxiety, referral to a psychologist/mental health worker was favoured. | Beliefs about capabilities, Environmental context and resources |
Preference to reduce use of drugs for insomnia but GPs felt insufficient resources or alternative management strategies were available | |||||
Hassed et al. (2012) [22] | Australia, Melbourne (metropolitan sample) | 15 General Practitioners | Focus groups (n = 7) and face-to-face interviews (n = 8). DSKQ | Scores from DSQK suggested gaps in knowledge related to defining the underlying cause and correct treatment options. | Knowledge, Skills, Environmental context and resources |
Behavioural intervention were viewed as preferable to prescribing medication. | |||||
Barriers to knowledge identified: limited training, lack of resources, patient expectation to receive a pill, consultation time constraint. | |||||
Cheung et al. (2014) [43] | Australia, Sydney (metropolitan sample) | GPs (n = 8) Pharmacists (n = 14) | Semi-structured interview from a convenience sample. Data analysed using a framework analysis | Practitioners perceived an overreliance on pharmacotherapy and inadequate support to direct patients to alternate pathways. | Environmental context and resources |
Patients often have a reliance or expectation of a ‘quick fix’. | |||||
Conroy & Ebben (2015) [44] | University of Michigan Hospitals and Weill Cornell Medical College of Cornell University. | Physicians (n = 239) | Questionnaire –mailed out | Most physicians did not nominate CBTi or a hypnotic as the most effective treatment for insomnia. | Knowledge, Skills |
1/3 recommended sleep hygiene. | |||||
N = 22 felt CBTi alone was effective. | |||||
Davy et al., (2015) [45] | Primary care in Nottinghamshire and Lincolnshire. | Health professionals (n = 23), and patients with insomnia (n = 28) | Focus groups, and interviews | Practitioners tended to focus on sleep hygiene rather than CBTi. | Knowledge, Skills, Behavioural Regulation |
Some practitioners felt they colluded with patients when prescribing hypnotics. | |||||
Patients often ignored sleep hygiene advice, and sometimes took hypnotics as not intended | |||||
Both practitioners and patients wanted more options and better training |