Introduction:Perinatal insomnia is a prevalent sleep concern that affects maternal and infant health. Although CBT-I is the recommended first-line treatment for insomnia, it is not routinely implemented in perinatal care in Australia. This study explored factors (barriers and facilitators) influencing sustainable implementation and scale-up of CBT-I in perinatal care, as investigated in the SHINE (Sleep-Health-in-Perinatal-Care) hybrid effectiveness-implementation type 1 randomised controlled trial.


Methods:507 pregnant females were randomised to either CBT-I or active control. CBT-I was delivered online through psychologist-led sessions and digital materials. Of the 252 randomised to CBT-I, 26 completed a semi-structured interview at six months postpartum to explore implementation. Seventeen key stakeholders (including obstetricians/gynaecologists, general practitioners, psychiatrists and psychologists), and four clinicians who delivered the program were interviewed. Interview guides were developed using implementation science theory. Interviews were analysed thematically to identify implementation barriers and facilitators.


Results:Preliminary results show that most participants found CBT-I beneficial, reporting improved sleep, wellbeing and strong understanding of CBT-I strategies. This was supported by clinicians, with majority observing sleep improvement during delivery. Most participants valued the flexible access to materials, which supported continued engagement postpartum. Some participants expressed insufficient support during postpartum, a concern echoed by clinicians who noted the need for additional structured follow-up/check-ins. Social support was identified by participants and clinicians as a key facilitator of CBT-I adherence. Lastly, stakeholders highlighted the need for clear referral and screening pathways, including easy-to-use tools and a streamlined pathway, alongside ongoing communication about program outcomes to maintain engagement.


Discussion:Participants and clinicians found CBT-I useful, with its flexible digital delivery promoting sustained strategy engagement. Clear referral pathways and ongoing communication with stakeholders are likely essential for scalability. Key barriers and facilitators, including maintenance treatment postpartum and social support, can inform design of a tailored implementation strategy to accelerate sustainable implementation and scale-up of CBT-I into routine care.