title: A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.
authors.affiliation: School of Health Sciences, Jönköping University, Jönköping, Sweden. anders.brostrom@hhj.hj.se
authors.forename: Anders
authors.initials: A
authors.lastname: Broström
authors.forename: Bengt
authors.initials: B
authors.lastname: Fridlund
authors.forename: Martin
authors.initials: M
authors.lastname: Ulander
authors.forename: Ola
authors.initials: O
authors.lastname: Sunnergren
authors.forename: Eva
authors.initials: E
authors.lastname: Svanborg
authors.forename: Per
authors.initials: P
authors.lastname: Nilsen
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic / Q000458:organization & administration*; D018794:Problem-Based Learning; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012959:Socioeconomic Factors