Date of Graduation

2017

Document Type

Dissertation

Degree Type

PhD

College

School of Nursing

Department

Adult Health

Committee Chair

Susan McCrone

Committee Co-Chair

Jamie DeCoster

Committee Member

Gina Maiocco

Committee Member

Hawley Montgomery-Downs

Committee Member

Mary Jane Smith

Abstract

Introduction: Obstructive sleep apnea (OSA) affects 25 million adults in the United States. Continuous positive airway pressure (CPAP) is the treatment of choice, but adherence is poor. Many previous CPAP adherence interventions were not theory based, tended to impose time and cost burden, and did not focus on OSA airway-brain mechanism education or OSA-CPAP performance feedback. A new, multidimensional intervention, known as CPAP-SAVER, was developed, based on the Theory of Planned Behavior (TPB), knowledge of CPAP facilitators and barriers, characteristics of CPAP adherers and nonadherers, and behavior change techniques. The purpose of this study was to examine the effect of the CPAP-SAVER intervention on adherence among adults with newly diagnosed OSA. Additional aims were to examine the effect of the intervention on anxiety, apnea beliefs, attitude, subjective norm, perceived behavioral control, and intention; predictors of intention and behavior were also determined.;Method: After IRB approval and consent, 66 participants from two home medical supply facilities were recruited over ten months for the experimental study. Participants were randomly assigned to intervention or standard care groups. Standard care included CPAP teaching and follow-up. The intervention involved support calls; the use of an airway model, video, education sheet, and report card; and standard care. Data were collected using a demographic survey, a TPB Questionnaire, the Apnea Beliefs Scale, the Beck Anxiety Inventory, the sleep study report, and the CPAP modem. Data were analyzed using SPSS 24, with alpha set at .05. Assumptions testing, scale reliability testing, frequencies, and descriptives were analyzed. Statistical analyses to answer the research questions included a chi-square test of independence, mixed between-within subjects ANOVAs, t-tests, and multiple and logistic regressions.;Results: There was no significant effect of the intervention on CPAP adherence at one month. Anxiety significantly decreased over time. Beliefs were higher at one month in the intervention group compared to standard care; there were no significant differences in attitude, subjective norm, or perceived behavioral control in the groups over time. CPAP adherence attitude, subjective norm, and perceived behavioral control significantly predicted CPAP adherence intention and explained 52.1% of the total variance; each of the variables demonstrated a significant, unique contribution to the variance in CPAP adherence intention. CPAP adherence intention significantly explained 14.1% to 21.0% of the variance in CPAP adherence behavior. Most intervention group participants rated the CPAP-SAVER intervention components as 3 or 4 (somewhat or extremely helpful, liked, understood, and motivating) on a Likert scale of 0 to 4.;Conclusion and Implications: The CPAP-SAVER study yielded mixed results, however, the intervention may provide groundwork for the eventual development of a clinical guideline for OSA-CPAP management to benefit both patients and practitioners. Replicating the CPAP-SAVER study in a larger, more diverse population and synthesizing the results with seminal works are the recommended next steps in translating this research into policy and practice.

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