title: Development of the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire.
abstract: BACKGROUND
  A growing number of positive airway pressure (PAP) device users will develop physical/sensory impairments such as arthritis. For these individuals, the usability of their PAP devices (e.g., efficiency and satisfaction) may impact the frequency and safety of device usage. Questionnaires to assess PAP usability are unavailable; therefore, we developed the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire.
  
  
  METHODS
  Questionnaire development included in-depth interviews to identify relevant content areas, a technical advisory panel to review/edit items, cognitive interviews to refine items, and a cross-sectional survey of Veterans Affairs sleep clinic patients assessing PAP device usability overall (one multi-item scale), usability of PAP components (multi-item scales for machine controls, mask/headgear, tubing, and humidifier), frequency of usability-related issues (one multi-item scale), PAP device characteristics, and demographics.
  
  
  RESULTS
  After conducting 19 in-depth interviews, a panel meeting, and 10 cognitive interviews, we administered the survey to 100 PAP device users (67% ≥60 years; 90% male). The items assessing machine control usability received the least favorable ratings. Twenty percent of respondents reported difficulty getting equipment ready for use, and 33 percent had difficulty cleaning equipment. The six multi-item scales had excellent internal consistency reliability (alpha ≥0.84) and item-rest correlations (≥0.39).
  
  
  CONCLUSIONS
  This study provides initial support for the USE-PAP for measuring PAP device usability. Studies that include large samples are needed to further evaluate the psychometric properties of the USE-PAP. In addition, comparisons of USE-PAP responses with direct observations of PAP-related tasks and objectively measured PAP adherence are needed to fully evaluate the questionnaire.
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Electronic address: cfung@ucla.edu.
authors.forename: Constance H
authors.initials: CH
authors.lastname: Fung
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martin
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Medicine Department, Pontificia Universidad Catolica de Chile, Santiago, Chile.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Rodriguez
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Uyi
authors.initials: U
authors.lastname: Igodan
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Stella
authors.initials: S
authors.lastname: Jouldjian
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Dzierzewski
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: B Josea
authors.initials: BJ
authors.lastname: Kramer
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Josephson
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Alessi
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000592:standards*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011594:Psychometrics; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: Adherence; Aging; Obstructive sleep apnea; Patient-reported measure; Positive airway pressure therapy