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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Why some embrace and others hesitate? A behavioral analysis of insomnia sufferers’ engagement with acupuncture treatment
Fei-Yi Zhao, Russell Conduit, Gerard A Kennedy, Pei-Jie Xu, Wen-Jing Zhang, Yuen-Shan Ho, Qiang-Qiang Fu, Chin-Moi Chow
Fei-Yi Zhao, Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai 201209, China
Fei-Yi Zhao, Chin-Moi Chow, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, New South Wales, Australia
Fei-Yi Zhao, Russell Conduit, Gerard A Kennedy, School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, Victoria, Australia
Fei-Yi Zhao, Wen-Jing Zhang, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
Pei-Jie Xu, School of Computing Technologies, RMIT University, Melbourne 3000, Victoria, Australia
Yuen-Shan Ho, School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
Qiang-Qiang Fu, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China
Chin-Moi Chow, Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, New South Wales, Australia
Co-first authors: Fei-Yi Zhao and Russell Conduit.
Co-corresponding authors: Yuen-Shan Ho and Qiang-Qiang Fu.
Author contributions: Zhao FY and Conduit R contributed equally to this study as co-first authors; Ho YS and Fu QQ contributed equally to this study as co-corresponding authors; Zhao FY conceptualized and designed the study, participated in the investigation, conducted the formal analysis, secured funding, and co-authored the original draft with Conduit R; Conduit R and Kennedy GA as native English speakers were responsible for enhancing the language quality of the manuscript; Xu PJ contributed to text translation, provided software support and data curation, and edited the manuscript; Zhang WJ participated in the formal analysis of the study, provided research resources, and contributed to revising the manuscript; Ho YS was involved in the investigation, the formal analysis, and the revision of the manuscript; Fu QQ contributed to the formal analysis, provided research resources, visualized the data, and participated in revising the manuscript; Chow CM contributed to the conceptualization and editing of the manuscript and the administration of the entire research project.
Supported by Scientific Research Fund Project of Shanghai Sanda University, No. 2024BSZX03.
Institutional review board statement: The study was reviewed and approved by the Human Research Ethics Committee of Shanghai Sanda University (Approval No. 2025001).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data used are confidential due to ethical restrictions.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Qiang-Qiang Fu, MD, Associate Chief Physician, Associate Professor, Yangpu Hospital, School of Medicine, Tongji University, No. 450 Tengyue Road, Yangpu District, Shanghai 200090, China.
qiangqiang.fu@tongji.edu.cn
Received: February 7, 2025
Revised: March 17, 2025
Accepted: April 3, 2025
Published online: May 19, 2025
Processing time: 82 Days and 11.6 Hours
BACKGROUND
Acupuncture is emerging as a promising treatment for insomnia. However, the determinants driving patients’ decisions to pursue or adopt this treatment modality remain underexplored.
AIM
To identify the key factors shaping the willingness of patients with insomnia to seek and engage in acupuncture from a patient-centered perspective.
METHODS
A semi-structured focus group design was used, with a research framework integrating the capability, opportunity, motivation-behavior model, and theoretical domains framework. The results were mapped onto constructs of a behavioral wheel derived from the capability, opportunity, motivation-behavior/theoretical domains framework matrix. Data analyses employed abductive thematic analysis.
RESULTS
Data saturation was achieved after ten focus group sessions, involving a total of 45 participants. Key facilitators for patients with insomnia seeking acupuncture included: (1) Cultural beliefs in ethnic medicine; (2) Concerns about the adverse effects of, and dependence on, hypnotics; (3) Expectations of improvement in comorbid symptoms; (4) Desire for more communication with the clinician; and (5) Incentives from peers and online key opinion leaders. Barriers were: (1) Limited knowledge of acupuncture indications; (2) Accessibility burden; (3) Needle-phobia; and (4) Safety concerns. Additionally, prior acupuncture experiences, family/friend attitudes, and treatment costs (reimbursement rate in health insurance) served as both facilitators and barriers.
CONCLUSION
The interrelated facilitators and barriers underscore that the decision to use acupuncture for insomnia is a complex issue involving efficacy/safety, culture, economics, information dissemination, and communication factors. Expanding patient education on acupuncture, increasing media exposure, and improving governmental oversight of this process are essential. Investing in high-quality acupuncture services in public hospital nighttime clinics and community health centers is expected to address accessibility challenges. Acupuncturists need to improve doctor-patient communication, including guiding patients to set treatment expectations that are grounded in reality to enhance service quality. For patients with significant needle-phobia, cognitive manipulation or hypnosis techniques may be employed to improve treatment compliance.
Core Tip: This medical-sociological interdisciplinary study examined factors influencing the decision of patients with insomnia to engage in acupuncture. Key facilitators included cultural beliefs, concerns about hypnotic dependence, and encouragement from key opinion leaders, while barriers encompassed limited knowledge, accessibility challenges, and needle-phobia. The findings underscore the multifaceted nature of this decision that is shaped by treatment efficacy, cultural context, economic factors, and communication dynamics. Recommendations for clinicians and policymakers include enhancing patient education, improving treatment accessibility through public health measures, fostering effective doctor-patient communication, and addressing needle-phobia through cognitive interventions to optimize treatment adherence and outcomes.
