Multidimensional challenges in promoting acupuncture for insomnia: Cultural, economic, and patient provider trust perspectives

Abstract

A recent study of patient-centered perspectives by Zhao et al, published in the World Journal of Psychiatry, identified key facilitators and barriers that influence insomnia patients’ choice of acupuncture therapy, offering insights for clinical practice and policy-making to enhance the integration of acupuncture therapy into comprehensive insomnia management. While acupuncture demonstrates unique advantages as a complementary medical approach, its broader adoption is hindered by complex multidimensional factors. This paper proposes a “dynamic balance model” encompassing the cultural, economic, and patient-provider trust dimensions, and emphasizes the need for synergistic optimization through cultural narrative transformation, institutional innovation, and digital empowerment. These strategies aim to facilitate the promotion of acupuncture for insomnia treatment and its global expansion.

Core Tip: This study proposes a dynamic balance model to address the multidimensional challenges in promoting acupuncture as an insomnia treatment, emphasizing cultural narrative transformation, institutional innovation, and digital empowerment. It highlights the need to reshape cultural perceptions of acupuncture as a scientifically validated therapy, improve economic accessibility through insurance reforms and community clinics, and enhance patient-provider trust using artificial intelligence-assisted platforms and digital communication tools. The model advocates for synergistic optimization across the cultural, economic, and communication dimensions to transition acupuncture from a marginal to a mainstream therapy, offering diverse therapeutic options and hope for insomnia patients globally.

INTRODUCTION

Insomnia, specifically chronic primary insomnia, has emerged as a global public health concern. Epidemiological studies show that approximately 30%-36% of adults report at least one symptom of insomnia at night[1]. Even when the more stringent and operational diagnostic criteria of the International Classification of Sleep Disorders, 3^rd edition are used, the prevalence remains between 6% and 10%[1]. Acupuncture has shown significant therapeutic potential for insomnia in recent studies[2,3]. However, its widespread adoption faces persistent challenges. Zhao et al[4] employed the capability, opportunity, motivation-behavior/theoretical domains framework to analyze the interplay of cultural, economic, and trust-related factors affecting the acceptance of acupuncture by patients, and proposed actionable solutions. These factors are not isolated but interact dynamically. Building on the above foundation, this paper introduces the “dynamic balance model” to explore the interdependencies among these factors and achieve multidimensional optimization for promoting acupuncture therapy.

RELEVANT FACTORS AND COUNTERMEASURES

Cultural identity

Traditional Chinese medicine (TCM) culture, as a form of “soft power” plays a vital role in fostering patient trust. In China, many patients opt for acupuncture due to cultural pride in ethnic medicine, a sentiment echoed in overseas Chinese communities. However, cultural identity also poses barriers to the global dissemination of acupuncture[5]. Overreliance on traditional concepts like “holism” without scientific articulation creates cognitive gaps among Western patients. Additionally, skepticism toward TCM’s “metaphysical” explanations, particularly among younger generations, hinders acceptance due to the lack of molecular biological evidence supporting acupuncture mechanisms.

Economic accessibility

Economic accessibility remains a critical bottleneck[6]. In China, limited insurance coverage for acupuncture imposes financial burdens on low-income populations. In Western countries with commercial insurance systems, a “payment willingness stratification” exists, where only high-income groups can afford acupuncture treatments[7]. Hidden costs, such as time investment (multiple sessions) and opportunity costs (absence from work), further exacerbate economic barriers, as these are seldom addressed by policies.

Patient-provider trust

Communication gaps between patients and providers may undermine trust in acupuncture. Studies reveal that patients often rely on social media influencers rather than medical professionals when choosing acupuncture, increasing the risk of misinformation[8]. Although studies have shown that the adverse effects of acupuncture are rare, they can be misunderstood because of exaggerated publicity[9]. Asymmetric information leads to unrealistic expectations, such as overestimating the efficacy of acupuncture for psychogenic insomnia. This type of “expectation bias” may compromise treatment outcomes and patient satisfaction, triggering trust crises.

The dynamic balance model

The above cultural, economic, and trust-related challenges are interconnected. For instance, cultural skepticism may deepen distrust in providers, while economic barriers weaken cultural affinity[4]. To address these issues, we propose the “dynamic balance model”, which emphasizes feedback loops among culture, economics, and communication.

Culturally, acupuncture must transition from a “traditional heritage” to a “scientifically validated brand”. Randomized controlled trials and neuroimaging evidence can reshape cultural narratives[10]. For example, framing acupuncture as “neuromodulation therapy” rather than “Eastern mysticism” in Western contexts reduces cultural dissonance[11]. Furthermore, evidence mapping studies indicate that acupuncture already has robust evidence in its support in many areas, but a substantial number of high-quality studies remain necessary[12].

Economically, shifting from mere “cost-sharing” to active “value co-creation” is essential for sustainable care. Publicly funded community clinics can offer preventative care and basic treatment locally, reducing expensive hospital visits. Optimized insurance schemes, like tiered pricing based on income, further lower out-of-pocket expenses, making essential insomnia care truly accessible[13].

In terms of communication, digital, securely built artificial intelligence (AI)-assisted platforms can enhance transparency by enabling real-time treatment progress tracking (e.g., visualization of sleep patterns) and personalized communication, thereby countering information asymmetry and expectation bias. These platforms must adhere to medical data-security standards and integrate reliable wearable devices to ensure data accuracy. Features like clinician dashboards displaying symptom reports help doctors proactively manage expectations, while patient-friendly tools (e.g., simplified booking) increase engagement with professional guidance[14]. Furthermore, verified online communities such as China’s “Haodf Online” can effectively combat misinformation from social media influencers by facilitating evidence-based discussions of authentic patient experiences, including treatment outcomes and management of side effects. Strict identity verification for providers, AI-aided content moderation, hospital partnerships, and regular security checks collectively rebuild trust through credible information exchange[15].

The proposed dynamic balance model offers transformative value by addressing three critical gaps in traditional acupuncture research for insomnia.

Integrated perspectives: Unlike siloed studies focusing either on biological efficacy or patient satisfaction, our model synergistically links scientific validation, socioeconomic accessibility (e.g., tiered insurance), and relational trust-building recognizing their interdependence in real-world adoption.

Proactive solution generation: While conventional models reactively analyze barriers, our framework actively leverages digital tools (e.g., AI platforms for expectation management, verified community case-sharing) to preempt trust erosion and cost-related discontinuation.

Scalable ecosystem foundation: By treating technological innovation (e.g., wearable-integrated progress tracking), policy redesign, and ethical communication as dynamically reinforcing elements, the model establishes a self-sustaining “acupuncture ecosystem” enabling continuous optimization where traditional static approaches stagnate.

CONCLUSION

Promoting acupuncture for insomnia requires overcoming multidimensional barriers rooted in culture, economics, and trust. The “dynamic balance model” advocates synergistic optimization through scientific cultural narratives, insurance innovations, and digital communication, which are key to transitioning acupuncture from a marginal to a mainstream therapy. The globalization of acupuncture is not merely cultural exportation but a process of scientific collaboration and institutional adaptation[16]. Future research should explore “acupuncture diplomacy” in the belt and road initiative countries and assess the long-term impacts of digital tools on patient-provider dynamics, such as algorithmic influences on medical authority. Through continuous innovation, a scientifically robust, equitable, and efficient global “acupuncture ecosystem” can be established, offering insomnia patients diverse therapeutic options and hope. While this study’s geographical scope is limited to China and Western countries due to the scarcity of published research on acupuncture dissemination in other regions, future studies should expand to include underrepresented areas, such as Southeast Asia, Africa, and Latin America, to address this data gap and enable comprehensive cross-regional comparisons.