Physiotherapists experiences with cognitive behavioural therapy for insomnia (CBT-I) training: Mixed methods study

Objective: Explore physiotherapists’ experiences with Cognitive Behavioural Therapy for Insomnia (CBT-I) training to understand factors that may influence implementation and upscaling of CBT-I training for physiotherapists. Method: Using a mixed-methods approach, data were collected through questionnaires and semi-structured interviews from twelve physiotherapists (3–27 years' experience) who completed a CBT-I training program consisting of online workshops and a pilot case. The Educational Course Assessment Toolkit (EDUCATOOL) evaluated reaction, learning, expected outcomes and behaviours in relation to the CBT-I training, and the Determinants of Implementation Behaviour Questionnaire (DIBQ), assessed barriers and enablers to the implementation of CBT-I. Interviews explored physiotherapists’ experiences of the training, guided by the theoretical framework of acceptability. Data were analysed thematically, with themes subsequently mapped to the Theoretical Domains Framework. Results: The median EDUCATOOL overall score was 92.38 (IQR = 87.35–99.00) out of 100.87% of DIBQ items were rated favourably to their respective domains (>4 on 7-point Likert scale). Four themes were generated from the interviews. Physiotherapists reported confidence in their capability to deliver CBT-I, reflecting (1) readiness for implementation in their professional role. (2) Training delivery and design contributed positively to knowledge acquisition. (3) Experiential learning enhanced understanding and confidence. However, physiotherapists noted (4) barriers affecting the integration of CBT-I in physiotherapy practice, including stakeholder engagement, and feasibility considerations related to billing, and delivery. Conclusion: Physiotherapists felt confident to deliver CBT-I following a training program. For successful upscaling, future initiatives must address identified systemic and practical barriers, including stakeholder engagement and delivery feasibility.