Principal Findings
sleepiness, UC
SECONDARY
We hypothesized that providing personalized CPAP education and feedback would be associated with increased adherence compared with UC. The results support this hypothesis. In addition, the intervention increased the outcome expectations and perceived importance of CPAP therapy, 2 psychological variables associated with CPAP use.Furthermore, we hypothesized that adherence would increase when the content of the intervention was delivered in a tailored versus nontailored style. However, the results do not support this hypothesis. In addition, style tailoring did not improve the psychological variables associated with CPAP use.In the subsequent paragraphs, we discuss the main findings.The results showed a significant main effect of personalized feedback and education on CPAP adherence for the 2 primary outcomes: hours of use per night and nights of use per week.There was a significant difference of 56.4 minutes (0.94 hours) of average use throughout the 90-day study period in favor of the group that received personalized feedback and education (PT + PN group) compared with the group that received UC (UC group). The rate of decline in nightly use was significantly smaller for the group that received personalized feedback and education (PT + PN group) than for the group that received UC (UC group), leading to a significant difference in the estimated average adherence based on minutes of use per night between the groups at study day 90 of 81.3 minutes in favor of the PT + PN group.A similar pattern was observed for nights of use per week. There was a significant difference of 0.9 average nights of use per week throughout the 90-day study period in favor of the group that received personalized education and feedback (PT + PN group) compared with the group that received UC (UC group). A significant group-by-time interaction effect was observed in favor of the PT + PN group compared with the UC group. The average difference of 0.9 nights per week between the groups at week 12 was significant.The results for the secondary adherence outcome measure of percentage of participants reaching the CMS adherence threshold showed that more participants in the PT + PN group reached the CMS adherence threshold than in the UC group, and the participants in the PT + PN group reached the threshold earlier, but the difference did not reach statistical significance.Looking at the secondary outcome variables related to sleepiness (ESS) and the psychological factors associated with CPAP use (outcome expectations, perceived importance, motivation, self-efficacy, and therapy satisfaction), significant group-by-time interactions were obtained for outcome expectations and perceived importance in favor of the PT + PN group. No other group-by-time interactions were observed. A main effect of group for perceived importance showed that the PT + PN group, on average, scored significantly higher on perceived importance. Main effects of time for ESS (Taken together, the results underscore the positive effect of providing personalized feedback and education on CPAP adherence and thereby support our first hypothesis. However, we did not find similarly strong support for our second hypothesis that tailoring the style of the content of the intervention would further increase adherence.Average adherence in terms of hours of use per night throughout the 90-day study period was not significantly different between the style-tailored (PT) and non–style-tailored (PN) groups. In addition, there was no group-by-time interaction effect and no main effect of group for the average nights of CPAP use per week for the PT and PN groups.In line with the primary outcomes, no significant effect of style tailoring was observed on the secondary adherence outcome of the percentage of participants reaching the CMS adherence threshold.Although no significant effects of style tailoring on adherence were obtained, significant group-by-time interaction effects of style tailoring were observed in favor of the PN group for 2 of the psychological factors: self-efficacy and therapy satisfaction. However, the differences in self-efficacy and therapy satisfaction between the groups were very small, and no differences were observed between the groups by the end of the study (day 90). In addition, there were no other main effects of group or time.Taken together, we were unable to find support for our second hypothesis that tailoring the style of the personalized education and feedback intervention to the psychological profile of the patient has an effect on CPAP adherence.