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A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea

Authors

  • Anders Broström RN PhD,

    Corresponding author
    1. Associate Professor, School of Health Sciences, Jönköping University, Jönköping, Sweden and Nurse Specialist, Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
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  • Bengt Fridlund RNT,

    1. Professor, School of Health Sciences, Jönköping University, Jönköping, Sweden
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  • Martin Ulander MD,

    1. Medical Doctor, Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden and Doctoral Candidate, Institution of Experimental and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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  • Ola Sunnergren MD,

    1. Doctoral Candidate, Institution of Experimental and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden and Medical Doctor, Ear, Nose and Throat Clinic, County Hospital Ryhov, Jönköping, Sweden.
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  • Eva Svanborg MD,

    1. Professor, Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden and Professor, Institution of Experimental and Clinical Medicine, Faculty of Health Sciences, Linkoping University, Linkoping Sweden
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  • Per Nilsen PhD

    1. Associate Professor, Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Department of Health and Society, Linköping University, Linköping, Sweden.
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Mr Anders Broström, Department of Clinical Neurophysiology, Linköping University Hospital, S-581 85 Linköping, Sweden, E-mail: anders.brostrom@hhj.hj.se

Abstract

Rationale, aims and objectives  Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation.

Educational programme  The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months.

Methods  A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach.

Results  72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle.

Conclusion and practice implications  A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.

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