Increasing adherence to obstructive sleep apnea treatment with a group social cognitive therapy treatment intervention: a randomized trial. Poor description of non-pharmacological interventions: analysis of consecutive sample of randomised trials Improving Compliance with Nasal CPAP and Vigilance in Older Adults with OSAHS Promoting Adherence An Evaluation of a Self-Management Program for Adults with Asthma A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial Patient education combined in a music and habit-forming intervention for adherence to continuous positive airway (CPAP) prescribed for sleep apnea. Test of an Interactive Voice Response Intervention to Improve Adherence to Controller Medications in Adults with Asthma A study of a multi-level intervention to improve non-adherence in difficult to control asthma. Motivational interviewing (MINT) improves continuous positive airway pressure (CPAP) acceptance and adherence: a randomized controlled trial. Feasibility, acceptability and preliminary effectiveness of patient advocates for improving asthma outcomes in adults Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial. The Impact of Educational Message Framing on Adherence to Continuous Positive Airway Pressure Therapy The effects of patient education in COPD in a 1-year follow-up randomised, controlled trial. Effectiveness of a group education session on adherence with APAP in obstructive sleep apnea—a randomized controlled study Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Individualized asthma self-management improves medication adherence and markers of asthma control. Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
OBJECTIVE To examine whether a social cognitive therapy ( SCT ) intervention increases continuous positive airway pressure ( CPAP ) use compared to equivalent social interaction ( SI ) time . PARTICIPANTS Individuals with obstructive sleep apnea ( OSA ) referred for CPAP therapy . INTERVENTION Participants received a 30-min group education session regarding OSA and CPAP . Groups of three to four participants were then r and omly assigned to an SCT session or social interaction . MEASUREMENTS CPAP usage was assessed at 7 nights , then 1 , 3 , and 6 months . The two primary outcomes were adherence , usage ≥ 4 h per night at 6 months , and uptake of CPAP . Question naires were given pretreatment and posttreatment . RESULTS Two hundred six individuals were r and omized to SI ( n = 97 ) or SCT ( n = 109 ) . CPAP uptake was not different between groups ( 82 % in SI , 88 % in SCT groups , P = 0.35 ) . There were no differences between groups in adherence : 63 - 66 % at 1 week , and at 6 months 55 - 47 % ( P = 0.36 ) . Higher pretreatment apnea-hypopnea index , higher baseline self-efficacy , and use of CPAP ( ≥ 4 h ) at 1 week were independent predictors of CPAP adherence at 6 months . CPAP adherence increased by a factor of 1.8 ( odds ratio = 1.8 , 95 % confidence interval 1.1 - 3.0 ) for every one-unit increase in self-efficacy . There was no difference between groups postintervention in self-efficacy scores , sleepiness , mood , or sleep quality . CONCLUSIONS In this r and omized trial , a single SCT application did not increase adherence when compared with SI time . Although self-efficacy scores prior to CPAP predicted adherence , self-efficacy was not increased by the interventions . Increasing intensity and underst and ing of SCT interventions may be needed to improve CPAP adherence . CLINICAL TRIALS REGISTRATION Australian New Zeal and Clinical Trials Registry , ACTRN12607000424404 Objectives To evaluate the completeness of descriptions of non-pharmacological interventions in r and omised trials , identify which elements are most frequently missing , and assess whether authors can provide missing details . Design Analysis of consecutive sample of r and omised trials of non-pharmacological interventions . Data sources and study selection All reports of r and omised trials of non-pharmacological interventions published in 2009 in six leading general medical journals ; 133 trial reports , with 137 interventions , met the inclusion criteria . Data collection Using an eight item checklist , two raters assessed the primary full trial report , plus any reference material s , appendices , or websites . Questions about missing details were emailed to corresponding authors , and relevant items were then reassessed . Results Of 137 interventions , only 53 ( 39 % ) were adequately described ; this was increased to 81 ( 59 % ) by using 63 responses from 88 contacted authors . The most frequently missing item was the “ intervention material s ” ( 47 % complete ) , but it also improved the most after author response ( 92 % complete ) . Whereas some authors ( 27/70 ) provided material s or further information , other authors ( 21/70 ) could not ; their reasons included copyright or intellectual property concerns , not having the material s or intervention details , or being unaware of their importance . Although 46 ( 34 % ) trial interventions had further information or material s readily available on a website , many were not mentioned in the report , were not freely accessible , or the URL was no longer functioning . Conclusions Missing essential information about interventions is a frequent , yet remediable , contributor to the worldwide waste in research funding . If trial reports do not have a sufficient description of interventions , other research ers can not build on the findings , and clinicians and patients can not reliably implement useful interventions . Improvement will require action by funders , research ers , and publishers , aided by long term repositories of material s linked to publications The present study examined the efficacy of a cognitive-behavioral intervention at improving compliance with CPAP  and vigilance in older adults with obstructive sleep apnea/hypopnea syndrome ( OSAHS ) . Participants included 12 subjects who were r and omized into one of two groups controlling for age , education , disease severity , and vigilance . The experimental group received two 45-min sessions design ed to educate subjects on the consequences of OSAHS and the efficacy of CPAP . The control group received the same extent of therapist contact but did not receive information on OSAHS or CPAP . All subjects were administered a test of vigilance both before and after the study . Compliance data were collected using CPAP devices with internal microprocessors at were read at 1 , 4 , and 12 weeks after treatment initiation . The results showed that the experimental condition did not enhance compliance after 1 week of treatment but did so by the 12-week follow-up . Subjects in the experimental condition had a run time of 3.2-h per night longer than did those in the control group . Those using CPAP more regularly at 12 weeks also showed greater improvement on vigilance at follow-up . Performance on vigilance testing before the introduction of CPAP was predictive of CPAP use at 12 weeks . In conclusion , a modest cognitive-behavioral intervention may substantially increase  CPAP use and vigilance in older adults This study compared the effects of a the oretically focused audiotape and a st and ard educational booklet on asthma preventive medication adherence and other asthma outcomes .  Forty-six adult asthmatics were r and omly assigned to receive either an experimental audiotape incorporating components of protection motivation theory , a st and ard asthma management booklet , both , or no educational material s. Outcomes were assessed at baseline , 3 months , and 6 months . Mean pharmacy-verified adherence improved 15 % to 19 % in the intervention groups and declined 22 % in the control group at 6 months . Using analysis of covariance ( ANCOVA ) to control for baseline adherence , these changes were significant between the control and booklet group ( t = 2.47 ; p = .02 ) and between control and combined group ( t = 2.07 ; p = .04 ) . Providing a minimal educational intervention can have a beneficial effect on asthma medication adherence that persists at least 6 months The purpose of this study was to evaluate the impact of a self-management program for adults with moderate to severe asthma on compliance with inhaled , prescribed , nonemergency medications ; asthma symptoms ; and airway obstruction . In this controlled experimental study , 55 subjects from a rural community were r and omized to one of two groups . Self-efficacy theory served as the framework for this study . Primary measures included the  Metered Dose Inhaler ( MDI ) Chronolog , a journal of daily asthma concerns , and a peak-flow meter to appraise airway obstruction . Secondary measures included the Asthma Self-Management Assessment Tool ( ASMAT ) and the Self-Efficacy for Asthma Management Scale ( SEAMS ) . These measures were completed pre- and post-intervention . Data analysis using descriptive and inferential statistics revealed that subjects receiving the self-management program increased compliance with inhaled medications ( U = 271 , p = .043 ) Background Continuous positive airway pressure ( CPAP ) is the most widely prescribed treatment for obstructive sleep apnoea syndrome ( OSAS ) . Although it has been shown to improve the symptoms of OSAS , many patients have difficulty adhering to this treatment . The purpose of this study was to investigate the effectiveness of an automated telemedicine intervention to improve adherence to CPAP . Methods A r and omised clinical trial was undertaken in 250 patients being started on CPAP therapy for OSAS . Patients were r and omly assigned to use a theory-driven interactive voice response system design ed to improve CPAP adherence ( telephone-linked communications for CPAP ( TLC-CPAP ) , n=124 ) or to an attention placebo control ( n=126 ) for 12 months . TLC-CPAP monitors patients ' self-reported behaviour and CPAP-related symptoms and provides feedback and counselling through a structured dialogue to enhance motivation to use CPAP . A Sleep Symptoms Checklist , the Functional Outcomes of Sleep Question naire , the Center for Epidemiological Studies Depression Scale and the Psychomotor Vigilance Task were administered at study entry and at 6-month and 12-month follow-up . Hours of CPAP usage at effective mask pressure were measured by the CPAP device stored in its memory and retrieved at each visit . Results Median observed CPAP use in patients r and omised to TLC-CPAP was approximately 1 h/night higher than in the control subjects at 6 months and 2 h/night higher at 12 months . Using generalised estimating equation modelling , the intervention had a significant effect on CPAP adherence . For secondary analysis , the effect of CPAP adherence on the secondary outcomes was analysed . CPAP adherence was significantly associated with a greater reduction in sleep apnoea symptoms and depressive symptoms and a greater improvement in functional status . No significant association was observed between CPAP adherence and reaction time . Conclusions The TLC-CPAP intervention result ed in improved CPAP adherence , which was associated with improved functional status and fewer depressive symptoms . Clinical trial.gov NCT00232544 OBJECTIVE As many as 50 % of patients diagnosed with obstructive sleep apnea stop adhering to the prescribed medical treatment of continuous positive airway pressure ( CPAP ) within 1 - 3 weeks of onset . Thus , a theory-based intervention using music to support habit formation was design ed to improve CPAP adherence at onset . The intervention material s included directions for CPAP nightly use , a diary for recording nightly use and writing about CPAP benefits or problems . In addition , an audiotape with softly spoken instructions for placing the CPAP mask comfortably , using deep breathing and muscle relaxation along with the slowly decreasing music tempo was provided to listen to at bedtime each night . METHODS Effects of this music intervention were tested in a r and omized , placebo-controlled trial of 97 patients with 53 males ( 55 % ) and 44 females ( 45 % ) . Moderate to severe apnea/hyponea scores ( per sleep laboratory data ) and medical diagnosis of OSA were required for study inclusion . RESULTS Compared to placebo controls , a greater proportion of experimental patients were adhering ( chi(2)=14.67 , p<0.01 ; a large difference , Phi=0.39 ) at the end of the first month of CPAP onset . There were no differences in CPAP adherence at 3 ( X(2)=0.065 , p=0.79 ) and 6 ( X(2)=.118 , p=0.73 ) months . Patients ' diary data and satisfaction survey results indicated the intervention was rated as helpful and guided formation of a relaxing , habitual routine of CPAP nightly use . CONCLUSION The intervention had a strong effect for improving adherence to CPAP at 1 month . PRACTICE IMPLICATION S Adherence at the onset of treatment is critical and the audio music intervention was easily administered . Other interventions that target problems interfering with longer-term CPAP adherence are needed Objective : This study was conducted to test the effectiveness of a theory-based interactive voice response ( IVR ) intervention to improve adherence to controller medications among adults with asthma . Methods : Fifty participants aged 18 to 65 years who had a physician diagnosis of asthma and a prescription for a daily inhaled corticosteroid , attended a baseline visit and a final visit 10 weeks later . Participants r and omized to the intervention group received 2 automated IVR telephone calls separated by one month , with one additional call if they reported recent symptoms of poorly controlled disease or failure to fill a prescription . Calls were completed in less than 5 minutes and included content design ed to inquire about asthma symptoms , deliver core educational messages , encourage refilling of inhaled corticosteroid prescriptions , and increase communication with providers . Adherence was tracked during 10 weeks , with objective measures that included either electronic monitors or calculation of canister weight . Participants completed the Asthma Quality of Life Question naire , the Asthma Control Test , and the Beliefs in Medications Question naire ( BMQ ) during both visits . Results : Adherence was 32 % higher among patients in the IVR group than those in the control group ( P = .003 ) . A more favorable shift in perception of inhaled corticosteroids was seen on BMQ scores of patients in the IVR group ( P = .003 ) , which in turn correlated with degree of adherence change ( r = 0.342 ; P = .0152 ) . No differences emerged for the Asthma Quality of Life Question naire or Asthma Control Test . Conclusions : The IVR intervention result ed in a significant increase in adherence to inhaled corticosteroid treatment and improved BMQ scores during the study interval . The association of increased adherence with increased BMQ scores suggests that the intervention succeeded in helping participants adopt a more favorable perception of their controller medication , leading in turn to improved adherence BACKGROUND Difficult to control asthma accounts for significant morbidity and healthcare cost , and non-adherence to medication is a common cause . It remains unclear if targeting non-adherence in this population improves healthcare outcomes . METHODS All subjects were referred to a Specialist Difficult Asthma Service ( 60 % from Respiratory physicians ) ; poor adherence was identified using prescription refill records for inhaled combination therapy . A sequential 2 phase study examined the effect of identifying and targeting non-adherence to inhaled long-acting β-agonist/inhaled steroid combination therapy ; phase 1 - an observational study utilising objective measures of non-adherence to facilitate a medical concordance discussion followed by phase 2 , a 12 month prospect i ve single blind r and omised controlled trial where subjects with persistent poor adherence were r and omised to a nurse-led menu driven intervention . RESULTS A total of 239 patients were assessed ; 31 of 83 subjects ( 37 % ) who were initially non-adherent , significantly improved adherence after concordance interview , with reduced prescribed daily dose of ICS ( data p<0.001 ) , rescue prednisolone courses ( data , p<0.001 ) and hospital admissions ( data , p=0.006 ) . With the menu driven intervention , adherence also improved ( intervention 37.6 % to 61.9 % , control group 31.7 % to 28.8 % ) with reduced maintenance oral steroid dose in subjects on maintenance steroids . CONCLUSION Poor adherence in difficult-to control asthma is common , but when identified and targeted can be improved and this is associated with large improvements in important healthcare outcomes . Previous nihilism towards non-adherence in this population is not supported by this study OBJECTIVE Adherence to continuous positive airway pressure ( CPAP ) therapy for obstructive sleep apnoea ( OSA ) is poor . We assessed the effectiveness of a motivational interviewing intervention ( motivational interview nurse therapy [ MINT ] ) in addition to best practice st and ard care to improve acceptance and adherence to CPAP therapy in people with a new diagnosis of OSA . METHOD One hundred six Australian adults ( 69 % male ) with a new diagnosis of OSA and a clinical recommendation for CPAP treatment were recruited from a tertiary sleep disorders center . Participants were r and omly assigned to receive either 3 sessions of a motivational interviewing intervention ( MINT ; n = 53 ; mean age = 55.4 years ) or no intervention ( control ; n = 53 ; mean age = 57.74 years ) . The primary outcome was the difference between the groups in objective CPAP adherence at 1-month , 2-month , 3-month , and 12-month follow-ups . RESULTS Fifty ( 94 % ) participants in the MINT group and 50 ( 94 % ) participants in the control group met all inclusion and exclusion criteria and were included in the primary analysis . The number of hours of CPAP use per night in the MINT group at 3 months was 4.63 hr and was 3.16 hr in the control group ( p = .005 ) . This represents almost 50 % better adherence in the MINT group relative to the control group . Patients in the MINT group were substantially more likely to accept CPAP treatment . CONCLUSIONS MINT is a brief , manualized , effective intervention that improves CPAP acceptance and objective adherence rates compared to st and ard care alone Abstract Background : Asthmatic adults from low-income urban neighborhoods have inferior health outcomes which in part may be due to barriers accessing care and with patient-provider communication . We adapted a patient advocate ( PA ) intervention to overcome these barriers . Objective : To conduct a pilot study to assess feasibility , acceptability and preliminary evidence of effectiveness . Methods : A prospect i ve r and omized design was employed with mixed methods evaluation . Adults with moderate or severe asthma were r and omized to 16 weeks of  PA  or a minimal intervention ( MI ) comparison condition . The PA , a non-professional , modeled preparations for a medical visit , attended the visit and confirmed underst and ing . The PA facilitated scheduling , obtaining insurance coverage and overcoming barriers to implementing medical advice . Outcomes included electronically-monitored inhaled corticosteroid ( ICS ) adherence , asthma control , quality of life , FEV1 , emergency department ( ED ) visits and hospitalizations . Mixed-effects models guided an intention-to-treat analysis . Results : 100 adults participated : age 47 ± 14 years , 75 % female , 71 % African – American , 16 % white , baseline FEV1 69 % ± 18 % , 36 % experiencing hospitalizations and 56 % ED visits for asthma in the prior year . Ninety-three subjects completed all visits ; 36 of 53 PA-assigned had a PA  visit . Adherence declined significantly in the control ( p = 0.001 ) but not significantly in the PA group ( p = 0.30 ) . Both PA and MI groups demonstrated improved asthma control ( p = 0.01 in both ) and quality of life ( p = 0.001 , p = 0.004 ) . Hospitalizations and ED visits for asthma did not differ between groups . The observed changes over time tended to favor the PA group , but this study was underpowered to detect differences between groups . Conclusion : The PA intervention was feasible and acceptable and demonstrated potential for improving asthma control and quality of life BACKGROUND Obstructive sleep apnea ( OSA ) is associated with a variety of medical conditions . Positive airway pressure ( PAP ) is an effective treatment for improving sleep , yet adherence rates are low . The aim of the current study is to test two treatments versus st and ard care in improving adherence to PAP . METHOD Two hundred twenty-seven patients with OSA were r and omized to st and ard care ( SC ) , education ( ED ) and motivational enhancement therapy ( MET ) .  Adherence was measured objective ly and the first week of adherence ( prior to the intervention ) was used as an a priori moderator of the effect of the various interventions . Mediators of treatment response were also examined using theory-based measures of decisional balance and self-efficacy . RESULTS Adherence declined over time for all three groups . There was a significant interaction between level of adherence during the first week of treatment and treatment group . Those who had moderate levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had MET ; those who had high levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had ED . MET treatment increased the perception of the positive aspects of PAP , but ED did not . CONCLUSIONS Initial adherence to positive airway pressure could help guide subsequent treatment plans . The results also support social cognitive theory in that educational approaches might be best suited for those who are ready for change whereas more motivational approaches might be best for those who are ambivalent about change Although of proven health benefit to persons with obstructive sleep apnea ( OSA ) , adherence to continuous positive airway pressure ( CPAP ) therapy is suboptimal , with patterns of use that are established early and that are not easily altered after the initial experience . In a r and omized controlled trial , 70 participants with OSA and cardiovascular disease were assigned to receive either positively or negatively framed education about CPAP . Objective adherence was measured following 30 days of home CPAP therapy .  Daytime sleepiness , dispositional optimism , self-efficacy , and depression were also evaluated at baseline and after 30 days .  CPAP use was greater in the group receiving negative message framing ( p = .015 ) The aims were to explore the effects and health economic consequences of patient education in patients with COPD in a 12-month follow-up . Sixty-two patients with mild to moderate Chronic Obstructive Pulmonary Disease ( COPD ) were at our out-patient clinic r and omly allocated to an intervention group or a control group . The intervention group participated in a 4h group patient education , followed by one to two individual nurse- and physiotherapist-sessions . Self-management was emphasised following a stepwise treatment plan .  Effectiveness was expressed in terms of number of general practitioner ( GP ) consultations , proportions in need of GP consultations , utilisation of rescue medication and patient satisfaction . Costs related to doctor visits , days off work , dispensed pharmaceuticals , hospital admissions , travel costs , educational and time costs were recorded . Patient education reduced the need for GP visits with 85 % ( from 3.4 to 0.5 , P<0.001 ) and kept a greater proportion independent of their GP during the 12-month follow-up , compared with no education ( 73 % versus 15 % , respectively ) . Patient education reduced the need for reliever medication from 290 to 125 Defined Daily Dosages ( DDD ) , and improved patient satisfaction with overall h and ling of their disease at GP . The control and intervention groups induced mean total costs of NOK 19,900 and 10,600 per patient , respectively . For every NOK put into patient education , there was a saving of 4.8 . The Number Needed to Educate ( NNE ) to make one person satisfied with their GP was 4.5 and associated with a concomitant saving of NOK 41,900 . Patient education of patients with COPD improved patient outcomes and reduced costs in a 12-month follow-up Purpose Auto-titrating continuous positive airway pressure ( APAP ) is an effective treatment for obstructive sleep apnea/hypopnea syndrome ( OSAHS ) . We investigated whether a single group education session on APAP therapy is effective in promoting adherence among patients with OSAHS . Methods This prospect i ve , r and omized , controlled , parallel group study included patients newly diagnosed with OSAHS who met criteria for APAP therapy . Patients were r and omized into a study group and a control group . All patients in the study group were assigned to a single group education session , 1 month after beginning APAP therapy . Results We evaluated 146 patients . The median percentage of APAP usage days was 88.3 % , with a median duration per day of use of 6.02 h ; 59 % were classified as adherent . Overall , no significant difference in adherence was seen between the study and the control groups . Analyzing patient subgroups , the group session significantly improved APAP adherence among males and patients who were younger ( < 65 years old ) , obese ( BMI ≥35 kg/m2 ) , non-sleepy ( Epworth sleepiness scale ≤11 ) , smokers or past smokers , had hypertension or nocturia and those with non-severe OSAHS . Conclusion To maximize the impact of group education sessions and , by that , saving re sources , it may be important to select patients likely to benefit from these sessions RATIONALE Poor adherence to asthma controller medications results in poor treatment outcomes . OBJECTIVES To compare  controller medication adherence  and clinical outcomes in 612 adults with poorly controlled asthma r and omized to one of two different treatment decision-making models or to usual care . METHODS In shared decision making ( SDM ) , nonphysician clinicians and patients negotiated a treatment regimen that accommo date d patient goals and preferences . In clinician decision making , treatment was prescribed without specifically eliciting patient goals /preferences . The otherwise identical intervention protocol s both provided asthma education and involved two in-person and three brief phone encounters . MEASUREMENTS AND MAIN RESULTS Refill adherence was measured using continuous medication acquisition ( CMA ) indices-the total days ' supply acquired per year divided by 365 days . Cumulative controller medication dose was measured in beclomethasone canister equivalents . In follow-up Year 1 , compared with usual care , SDM result ed in : significantly better controller adherence ( CMA , 0.67 vs. 0.46 ; P < 0.0001 ) and long-acting beta-agonist adherence ( CMA , 0.51 vs. 0.40 ; P = 0.0225 ) ; higher cumulative controller medication dose ( canister equivalent , 10.9 vs. 5.2 ; P < 0.0001 ) ; significantly better clinical outcomes ( asthma-related quality of life , health care use , rescue medication use , asthma control , and lung function ) . In Year 2 , compared with usual care , SDM result ed in significantly lower rescue medication use , the sole clinical outcome available for that year . Compared with clinician decision making , SDM result ed in : significantly better controller adherence ( CMA , 0.67 vs. 0.59 ; P = 0.03 ) and long-acting beta-agonist adherence ( CMA , 0.51 vs. 0.41 ; P = 0.0143 ) ; higher cumulative controller dose ( CMA , 10.9 vs. 9.1 ; P = 0.005 ) ; and quantitatively , but not significantly , better outcomes on all clinical measures . CONCLUSIONS Negotiating patients ' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes . Clinical trials registered with www . clinical trials.gov ( NCT00217945 and NCT00149526 ) BACKGROUND Adherence to inhaled anti-inflammatory therapy and self-management skills are essential parts of the asthma treatment plan to improve asthma control and prevent exacerbations . Whether self-management education improves long-term medication adherence is less clear . OBJECTIVE A 24-week prospect i ve , r and omized controlled trial was performed to study the effect of self-management education on long-term adherence to inhaled corticosteroid ( ICS ) therapy and markers of asthma control . METHODS After stabilization on ICS medication during a run-in phase , 95 adults with moderate-to-severe asthma were recruited from a large metropolitan community , and 84 were r and omized to individualized self-management education , including self-monitoring of symptoms and peak flow or usual care with self-monitoring alone .  The key components of the 30-minute intervention were asthma information , assessment , and correction of inhaler technique ; an individualized action plan based on self-monitoring data ; and environmental control strategies for relevant allergen and irritant exposures . The intervention was personalized based on pulmonary function , allergen skin test reactivity , and inhaler technique and reinforced at 2-week intervals . RESULTS Participants r and omized to the self-management intervention maintained consistently higher ICS adherence levels and showed a 9-fold greater odds of more than 60 % adherence to the prescribed dose compared with control subjects at the end of the intervention ( P = .02 ) and maintained a 3-fold greater odds of higher than 60 % adherence at the end of the study . Perceived control of asthma improved ( P = .006 ) , nighttime awakenings decreased ( P = .03 ) , and inhaled beta-agonist use decreased ( P = .01 ) in intervention participants compared with control subjects . CONCLUSION Our results show that individualized asthma self-management education attenuates the usual decrease in medication adherence and improves clinical markers of asthma control STUDY OBJECTIVE To improve adherence to continuous positive airway pressure ( CPAP ) treatment in participants with obstructive sleep apnea ( OSA ) using a cognitive behavioral therapy ( CBT ) intervention . DESIGN A r and omized controlled trial . SETTING A major teaching hospital in Sydney ( 2005 ) . PARTICIPANTS One hundred individuals ( 96 men ) , ranging in age from 32 to 81 years , diagnosed with OSA . INTERVENTION Two 1-hour CBT interventions ( including a video of real CPAP users ) plus treatment as usual ( mask fitting and information ) or treatment as usual only . MEASUREMENTS AND RESULTS Hours of CPAP usage was assessed at 7 nights and 28 nights . Adherence was defined as usage at least 4 hours per night . Question naires measuring self-efficacy , social support , and expectancy ( mediators of adherence ) were given after intervention or after usual treatment . A higher adherence to CPAP therapy was found in the CBT group ( 2.9 hours difference ) relative to treatment as usual ( P < 0.001 ) at 28 days . Only 4 participants in the CBT group did not initiate treatments after their titration study , compared with 15 in the treatment as usual group ( P < 0.02 ) . The CBT group had significantly higher scores for self-efficacy ( P < 0.001 ) and social support P < 0.008 ) but not for expectancy . CONCLUSIONS The CBT intervention result ed in both increased adherence and " uptake " of CPAP and therefore would be expected to reduce the social , economic , and health-related consequences of untreated OSA The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials
BACKGROUND We sought to describe the theory used to design treatment adherence interventions , the content delivered , and the mode of delivery of these interventions in chronic respiratory disease .