title: Perceived Effectiveness, Self-efficacy, and Social Support for Oral Appliance Therapy Among Older Veterans With Obstructive Sleep Apnea.
abstract: Obstructive sleep apnea is a prevalent sleep disorder among older adults. Oral appliances are increasingly prescribed as therapy for obstructive sleep apnea. Adherence to oral appliance therapy is highly variable. Based on value-expectancy theory and other social-psychological theories, adherence to oral appliance therapy may be influenced by patients' perceived effectiveness of the therapy, self-efficacy, and availability of social support. We examined these perceptions among older adults with obstructive sleep apnea who were prescribed oral appliance therapy.
  
  
  
  We mailed surveys to all patients aged ≥65 years who had been prescribed oral appliance therapy for obstructive sleep apnea over the prior 36 months at a Veterans Affairs medical center. We examined frequencies of responses to items that assessed perceived effectiveness, self-efficacy, and social support for nightly use of oral appliances from friends, family, or health care staff.
  
  
  
  Thirty-nine individuals responded (response rate, 30%; mean [SD] age 71.4 [SD 6.3] years; 97% male). Thirty-six percent of the respondents perceived regular use of oral appliance therapy to be effective in managing obstructive sleep apnea; 39% agreed that they felt confident about using oral appliances regularly; 41% felt supported by people in their life in using oral appliance therapy; and 38% agreed that health care staff would help them to use their oral appliance regularly. These rates represented less than half of respondents despite the finding that 65% of patients believed that they would use their oral appliance regularly.
  
  
  
  Although oral appliance therapy is increasingly prescribed for obstructive sleep apnea, only about one third of older adults prescribed it perceived it to be an effective treatment, were confident about oral appliance use, and/or believed that they would receive needed support. Future research is needed to better understand older adults' perceptions so that interventions can be designed to improve the effectiveness of oral appliances, their self-efficacy for using oral appliances, and their social support for this therapy, which may, in turn, improve oral appliance therapy adherence.
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles. Electronic address: constance.fung@va.gov.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Carballo
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, University of California, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Alessi
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martin
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mitchell
authors.affiliation: Department of Medicine, University of California, Los Angeles, California.
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.affiliation: Center of Excellence in the Neurosciences, University of New England, Biddeford, Maine.
authors.forename: Nananda
authors.initials: N
authors.lastname: Col
authors.affiliation: School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Patterson
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Stella
authors.initials: S
authors.lastname: Jouldjian
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors.forename: Karen
authors.initials: K
authors.lastname: Josephson
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, University of California, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Constance H
authors.initials: CH
authors.lastname: Fung
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010465:Perception; D020377:Self Efficacy; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D012944:Social Support; D016896:Treatment Outcome; D014728:Veterans
keywords: attitude to health; oral appliance therapy; patient reported measures; sleep apnea syndromes