Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners' beliefs and practices

Anders Broström; Amir H Pakpour; Per Nilsen; Benjamin Gardner; Martin Ulander

doi:10.1111/jsr.12675

Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners' beliefs and practices

J Sleep Res. 2018 Dec;27(6):e12675. doi: 10.1111/jsr.12675. Epub 2018 Mar 1.

Authors

Anders Broström^{1

2}, Amir H Pakpour^{3

4}, Per Nilsen⁵, Benjamin Gardner⁶, Martin Ulander^{2

7}

Affiliations

¹ Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
² Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
³ School of Health and Welfare, Jönköping University, Jönköping, Sweden.
⁴ Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
⁵ Division of Health Care Analysis, Faculty of Health Sciences, Department of Health and Society, Linköping University, Linköping, Sweden.
⁶ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁷ Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.

PMID: 29493035
DOI: 10.1111/jsr.12675

Abstract

The benefits of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea are well established, but adherence tends to be low. Research exploring CPAP practitioners' beliefs around determinants of CPAP adherence, and the actions they use in clinical practice to promote CPAP adherence is lacking. This study aimed to: (i) develop and validate a questionnaire to assess beliefs and current practices among CPAP practitioners; (ii) explore practitioners' beliefs regarding the main determinants of patient adherence, and the actions practitioners most commonly use to promote CPAP adherence; and (iii) explore the associations between perceived determinants and adherence-promotion actions. One-hundred and forty-two CPAP practitioners in Sweden and Norway, representing 93% of all Swedish and 62% of all Norwegian CPAP centres, were surveyed via a questionnaire exploring potential determinants (18 items) and adherence-promotion actions (20 items). Confirmatory factor analysis and second-order structural equational modelling were used to identify patterns of beliefs, and potential associations with adherence-promotion actions. Patients' knowledge, motivation and attitudes were perceived by practitioners to be the main determinants of CPAP adherence, and educating patients about effects, management and treatment adjustments were the most common practices. Knowledge was shown to predict educational and informational actions (e.g. education about obstructive sleep apnea and CPAP). Educational and informational actions were associated with medical actions (e.g. treatment adjustment), but knowledge, attitude and support had no association with medical actions. These findings indicate that a wide variety of determinants and actions are considered important, though the only relationship observed between beliefs and actions was found for knowledge and educational and informational actions.

Keywords: adherence; continuous positive airway pressure; obstructive sleep apnea; patient education.

MeSH terms

Adult
Continuous Positive Airway Pressure / methods
Continuous Positive Airway Pressure / trends*
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Norway / epidemiology
Patient Compliance*
Sleep Apnea, Obstructive / diagnosis
Sleep Apnea, Obstructive / epidemiology*
Sleep Apnea, Obstructive / therapy*
Surveys and Questionnaires*
Sweden / epidemiology