Effectiveness of Digital Cognitive Behavioral Therapy for Insomnia in Frontline Health Care Workers (The HCW-CBTi Study)

Change in score on the Insomnia Severity Index (ISI ) from baseline to 12 weeks. ISI is a 7-item self-report questionnaire that assesses insomnia's nature, severity, and impact. Responses can range from 0 to 4, where higher scores indicate more acute symptoms of insomnia. The score can be classified in the following way:

the total score of 0-7 indicates "no clinically significant insomnia," 8-14 means "subthreshold insomnia," 15-21 is "clinical insomnia (moderate severity)," and 22-28 means "clinical insomnia (severe).

It is an eight-item rating scale that was developed to screen for insomnia disorder based on DSM-5 criteria. Each item was scored on a 5-point scale (0-4), with lower scores, in the 0-2 range, reflecting putative threshold criteria for insomnia disorder. The possible total score ranges from 0 to 32, with higher values than 16 indicative of better sleep.

The SCI is valid, reliable, and sensitive to change.

The PROMIS Sleep Disturbance is an eight-item scale that assesses self-reported perceptions of sleep quality, sleep depth, and restoration associated with sleep. Each item on the measure is rated on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always) with a range in score from 8 to 40 with higher scores indicating greater severity of sleep disturbance. The raw scores on the 8 items should be summed to obtain a total raw score.

The PROMIS Sleep-Related impairment is an eight-item scale that focuses on self-reported perceptions of alertness, sleepiness, and tiredness during usual waking hours, and the perceived functional impairments during wakefulness associated with sleep problems or impaired alertness. Each item on the measure is rated on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always) with a range in score from 8 to 40 with higher scores indicating greater severity of sleep disturbance. The raw scores on the 8 items should be summed to obtain a total raw score.

The GAD-7 is a valid and efficient tool for screening and assessing the severity of generalized anxiety disorder (GAD) in clinical practice and research. Screening for anxiety disorders, a score of 8 or greater represents a reasonable cut-point for identifying probable cases of generalized anxiety disorder; The following cut-offs correlate with the level of anxiety severity:

• Score 0-4: Minimal Anxiety
• Score 5-9: Mild Anxiety
• Score 10-14: Moderate Anxiety
• Score greater than 15: Severe Anxiety.

14 items to measure feeling and functional aspects of mental well-being. The WEMWBS is scored by summing the scores for each of the 14 items, which are scored from 1 to 5. The 14-item scale WEMWBS has 5 response categories, summed to provide a single score. Scores range from 14 to 70 and higher scores indicate greater positive mental wellbeing.

5 items to measure functional impairment attributed to a given disorder.5 items can be scored from 0 to 8. A score of all Items will be summed up. WSAS score >20 reflects severe or worse psychopathology., 10 to 20 reflects significant functional impairment but less severe clinical symptomatology and <10 appears to signify subclinical disorders populations.

22 items to measure current subjective distress due to traumatic life events. The Impact of Event Scale has a scoring range of 0 to 88and a score above 24 is meaningful. A score of 24 or more will have partial PTSD or at least some of the symptoms. A score of 33 and above is a probable diagnosis of PTSD. A score of 37 or more is high enough to suppress the immune system's functioning.

It consists of 6 items to measure impairments in works. The sum of specific health problem impairment and impairment due to other health reasons is equal to impairment due to all health reasons. WPAI outcomes are expressed as impairment percentages, with higher numbers indicating greater impairment and less productivity, i.e., worse outcomes.

22 items to measure burnout in medical professionals. Responses are scored on a six-point Likert scale, ranging from 0 = never to 6 = every day, for each subscale, and tabulated into three tiers (low, moderate, or high). Emotional Exhaustion (EE)-9 questions, Depersonalization (DP)-5 questions, and self-perceived lack of Personal Accomplishment (PA)-8 questions.

Based on the reference ranges provided with the MBI-HSS: for EE, low (0-16), moderate (17-26), and high (≥27); for DP, low (0-6), moderate (7-12) and high (≥13), and finally, for PA, low (≤31), moderate (32-38) and high (≥39). Burnout was defined by the updated Maslach-recommended criteria of "high EE and high DP" or "high EE and low PA"

PGIC is a 7-point scale depicting a patient's rating of overall improvement. Patients rate their change as "very much improved," "much improved," "minimally improved," "no change," "minimally worse," "much worse," or "very much worse." PGIC is commonly used to evaluate the overall improvement or change in symptoms following treatment and is an important indicator of significant change in treatments of chronic pain.

5 items can be scored from 1 to 7. The higher score signifies the greater Depth, Smoothness, and Positivity, of therapy.

Acceptability E-scale has strong psychometric properties and can be useful in assessing the acceptability and usability of computerized health-related programs. The score was rated on five Likert-type scale responses; 1-strongly disagree; 2disagree; 3-not sure; 4-agree; 5-strongly agree. A score of 40 or above indicates that program iss feasible for the use.

Each item on the measure is rated on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always) with a range in score from 8 to 40 with higher scores indicating greater severity of sleep disturbance.