{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:49:50Z","timestamp":1781916590066,"version":"3.54.5"},"reference-count":32,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,7,11]]},"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Insomnia is highly prevalent in prisoners and is a risk factor for poor mental well-being, depression, suicidality and aggression, all common concerns in this vulnerable population. Improving sleep management options in prison offers the potential to impact positively on a number of these common risk factors. The study aim was to design a treatment pathway for insomnia in prisons informed by stakeholders with professional or lived experience of insomnia and prison-based interventions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A modified Delphi technique, adapted to the stakeholder (either receiving controlled feedback online or face to face on a series of statements), was used over three rounds to gain consensus on a final treatment pathway design.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Academic sleep researchers, prison staff and prisoners were invited to develop the treatment pathway.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fifteen stakeholders took part in round 1 and thirteen in round 2. There were six statements of contention that comprised concerns over the inclusion of sleep observations, sleep restriction therapy and promethazine. Consensus was high (&gt;80%). Thirteen stakeholders agreed the final pathway in round 3. The final treatment pathway comprised a standardised stepped-care approach for insomnia in prison populations. The pathway resulted in five main stages: (1) transition from community; (2) detection and assessment; (3) treatment for short-term insomnia; (4) treatment for long-term insomnia and (5) transition from prison to community or another establishment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The treatment pathway is designed to promote early detection of insomnia, potentially reducing unnecessary prescriptions and medication trading, misuse and diversion in the prison setting. It should make a substantial difference in reducing the large number of sleep complaints and positively impact on prisoners, staff and the prison environment. Specifically, improving sleep should have a positive impact on prisoners\u2019 mental and physical well-being and aid smooth running of the prison.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022406","type":"journal-article","created":{"date-parts":[[2018,8,29]],"date-time":"2018-08-29T11:37:07Z","timestamp":1535542627000},"page":"e022406","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Design of a treatment pathway for insomnia in prison settings in England: a modified Delphi study"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8359-8834","authenticated-orcid":false,"given":"Lindsay H","family":"Dewa","sequence":"first","affiliation":[{"name":"NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK"},{"name":"School of Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamiece","family":"Hassan","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Shaw","sequence":"additional","affiliation":[{"name":"Offender Health Research Network, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Senior","sequence":"additional","affiliation":[{"name":"Offender Health Research Network, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,8,29]]},"reference":[{"key":"2025101812335723000_8.8.e022406.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2009.07.004"},{"key":"2025101812335723000_8.8.e022406.2","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.5664\/jcsm.26929","article-title":"Insomnia: definition, prevalence, etiology, and consequences","volume":"3","author":"Roth","year":"2007","journal-title":"J Clin Sleep Med"},{"key":"2025101812335723000_8.8.e022406.3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.smrv.2014.12.002","article-title":"Prevalence, associated factors and management of insomnia in prison populations: An integrative review","volume":"24","author":"Dewa","year":"2015","journal-title":"Sleep Med Rev"},{"key":"2025101812335723000_8.8.e022406.4","doi-asserted-by":"publisher","DOI":"10.1053\/smrv.2002.0186"},{"key":"2025101812335723000_8.8.e022406.5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.sleep.2016.12.018","article-title":"Trouble sleeping inside: a cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England","volume":"32","author":"Dewa","year":"2017","journal-title":"Sleep Med"},{"key":"2025101812335723000_8.8.e022406.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2011.12.006"},{"key":"2025101812335723000_8.8.e022406.7","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.ijlp.2016.02.014","article-title":"Sleep and its association with aggression among prisoners: Quantity or quality?","volume":"47","author":"Barker","year":"2016","journal-title":"Int J Law Psychiatry"},{"key":"2025101812335723000_8.8.e022406.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2009.10.007"},{"key":"2025101812335723000_8.8.e022406.9","first-page":"553","article-title":"Sleep deprivation: Impact on cognitive performance","volume":"3","author":"Alhola","year":"2007","journal-title":"Neuropsychiatr Dis Treat"},{"key":"2025101812335723000_8.8.e022406.10","unstructured":"NICE. 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