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

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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.