Application Of Health Action Process Approach In Adherence To Continuous Positive Airway Pressure In Patients With OSAHS

Objectives1. To develop the Chinese version of Self-Efficacy Measure for Sleep Apnea and evaluate its feasibility, reliability and validity.2. To explore and verify the effectiveness of menu-based intervention on intention, adherence to CPAP, sleep quality and quality of life in patients with obstructive sleep apnea syndrome.Method1. Chinese version of SEMSA was introduced into China Mainland through translating, and back-translating, as well as cross-cultural adapting of the original SEMSA. A total of85OSAHS patients completed the Chinese version of SEMSA. The feasibility and internal consistency, split-half reliability and construct validity were evaluated.2.114patients with newly diagnosed OSAHS were randomly assigned into risk communication (RC) group, self-efficacy (SE) group and control group (38patients in each group). The participants in the control group received the routine care, and the participants in the RC and SE groups received the routine care and the stage-matched interventions. The intervention was based on the Health Action Process Approach theory. The behavior change was divided into three phase:diagnosed PSG night, CPAP titration night and home CPAP usage. Primary outcome measures were assessed at baseline,1,3,6months follow-up, including:1) the Self-efficacy Measure for Sleep Apnea2) the Pittsburgh Sleep Quality Index3) QSQ quality of life4) adherence data.Results1. The recovery rate of the Chinese version of SEMSA was97.65%, with a response rate as95.29%, and the completion of the C-SEMSA was10.3±3.12min. The Cronbach’s a coefficient for C-SEMSA was0.886, and for the three subscales was0.750～0.895. The split-half coefficient for the total scale and three subscales was0.851and0.630～0.797respectively. The varimas rotation factor analysis of the C-SEMSA identified six principal factors and explained total for 69.498%variances, and the majority of items has moderate to strong loading on its corresponding factors.2. There was significant difference in the intention on CPAP treatment among three groups(P<0.05).92.11%of participants in RC group made their decisions to continue CPAP treatment, compared with78.95%of SE group and60.53%of control group.3. Reaptted measures analysis of variance demonstrated that main intervention effect and the main time effect on risk perception, outcome expectancy and self-efficacy (P<0.05) were significant. There was significant interaction between time and intervention on self-efficacy and outcome expectancy(P<0.05). The interaction diagram indicated that the risk perception in the RC group was higher than that of in SE and control groups over time at follow-ups; the self-efficacy in the SE group was higher than that of in the RC and control groups.4. Compared with RC and control group, SE group showed greater average CPAP usage at3months (P<0.05). Mean nightly usage in the SE group was1.04h and0.56h per night higher than that of the control and RC group at6month (P<0.05), only0.48h higher in the RC group than that of in the control group(P<0.05).5. After intervention, there was a significant improvement in sleepiness, sleep quality and quality of life in each of groups. The SE group showed significant improvement in PSQI and QSQ scores (P<0.05)Conclusions1. The Chinese version of SEMSA demonstrated good reliability and validity and, thus, could be a suitable instrument in evaluating self-efficacy in patients with OSAHS.2. The menu-based intervention may result in greater intention, higher adherence rates, greater improvement in sleep quality and quality of life in patients with OSAHS.3. For patients with no intention, the risk communication may be a stage-matched intervention; a motivated patients may benefit from self-efficacy intervention.