OurSleepKit: A Couple-focused mHealth Tool to Support Adherence to CPAP Treatment

项目总结 持续气道正压(CPAP)治疗依从性差仍然是最大的单一治疗 阻碍阻塞性睡眠呼吸暂停(OSA)的有效管理，导致发病率增加， 死亡率和更高的医疗保健成本。现有的促进CPAP遵守的干预措施只关注 确诊的患者大多由卫生专业人员接生，但收效甚微。如所支持的 PI的R15项目的发现，患者的伴侣扮演着重要的角色-无论是积极的还是消极的- 对CPAP的遵守，是CPAP使用的所有主要促进方面和障碍的一部分。一个二元数 让患者和伴侣共同参与促进CPAP遵从性的方法仍未得到开发 机会。我们的跨学科团队已经开发了OurSleepKit的原型，这是一种创新的 以夫妇为重点的mHealth工具，以促进CPAP的遵守。以合作伙伴的概念框架为指导 参与CPAP遵守，OurSleepKit的目标是指导相互参与并树立积极的榜样 合作伙伴参与CPAP治疗，从而激励更多的CPAP坚持。对PA-18的回应- 722，这个R01项目的目标是改进和测试OurSleepKit以支持对CPAP治疗的坚持。我们 将在已建立的安全mHealth平台NUCoach上改进和部署OurSleepKit。让用户访问 参与mHealth干预是其成功的关键，用户对现有mHealth的参与度较低 工具仍然是一个大问题。为了解决这个问题，我们将使用参与式方法来改进OurSleepKit 并全面评估其对CPAP遵守和用户参与度的影响。具体来说，我们将 1)在标准化迭代参与式方法中使用定性方法改进OurSleepKit 与最终用户(OSA患者及其伴侣)合作；2)检查OurSleepKit的有效性 对180对夫妇进行为期6个月的随机平行组对照试验 诊断出的阻塞性睡眠呼吸暂停患者及其伴侣)；以及3)通过以下方式评估干预组中的用户参与度 跟踪目标OurSleepKit的使用情况并了解主观用户体验。本项目的成果 将支持开发一个有效和吸引人的mHealth工具，该工具可以很容易地被OSA采用 患者和他们的伴侣支持坚持CPAP治疗。在给定的频率和深度下 大多数患者与他们的伴侣OurSleepKit的互动可能会取得成功，并产生可持续的效果 关于坚持CPAP会带来显著的健康益处。如果证明是成功的，OurSleepKit可以很容易地 与其他干预措施和现有技术相结合，更好地促进CPAP的使用。这款新的mHealth 干预有助于将目前OSA的护理从以疾病为重点的反应性模式转变为更多 积极主动的自我管理模式。除了OSA，OurSleepKit可以成为使用mHealth的典范 优化治疗依从性和让家庭护理伙伴参与的自我管理的技术。

PROJECT SUMMARY Poor adherence to continuous positive airway pressure (CPAP) treatment remains the single largest impediment to effective management for obstructive sleep apnea (OSA) leading to increased morbidity, mortality, and higher health care costs. Existing interventions promoting CPAP adherence focus only on the diagnosed individual and are delivered mostly by health professionals, with limited success. As supported by the findings of the PI’s R15 project, the partners of patients play a significant role – either positive or negative – in CPAP adherence, and are part of all of the major facilitative aspects and barriers to CPAP use. A dyadic approach engaging both the patient and partner to promote CPAP adherence remains an untapped opportunity. Our interdisciplinary team has developed a prototype of OurSleepKit, which is an innovative couple-focused mHealth tool to promote CPAP adherence. Guided by the conceptual framework of partner involvement in CPAP adherence, the goal of OurSleepKit is to coach mutual engagement and model positive partner involvement in CPAP treatment, thus motivating greater CPAP adherence. Responding to the PA-18- 722, the goal of this R01 project is to refine and test OurSleepKit to support adherence to CPAP treatment. We will refine and deploy OurSleepKit on an established secure mHealth platform, NUCoach. Getting users to engage with an mHealth intervention is critical to its success, and low user engagement with existing mHealth tools remains a big concern. To address this issue, we will use a participatory approach to refine OurSleepKit and comprehensively evaluate both its effect on CPAP adherence and user engagement. Specifically, we will 1) Refine OurSleepKit using qualitative methods within a standardized iterative participatory approach by working with end users (OSA patients and their partners); 2) Examine the effectiveness of OurSleepKit on CPAP adherence by conducting a 6-month randomized parallel group controlled trial in 180 couples (newly diagnosed OSA patients and their partners); and 3) Evaluate user engagement in the intervention group by tracking objective OurSleepKit usage and understanding the subjective user experience. Results of this project will support the development of an effective and engaging mHealth tool which can be readily adopted by OSA patients and their partners to support adherence to CPAP treatment. Given the frequency and depth of interaction that most patients have with their partner, OurSleepKit is likely to succeed with a sustainable effect on CPAP adherence leading to significant health benefits. If shown to be successful, OurSleepKit can be easily integrated with other interventions and existing technology to better promote CPAP use. This new mHealth intervention facilitates changing the current care of OSA from a reactive disease-focused model to a more proactive self-management model. Going beyond OSA, OurSleepKit can be an exemplar of using mHealth technology to optimize treatment adherence and self-management involving family care partners.