Treatment Adherence Patterns in Rural Georgian Veterans with Sleep Apnea: An Anthropological Approach Open Access
Hsieh, Sharon (Spring 2018)
Abstract
Sleep Medicine has evolved rapidly over the past six decades, reflecting increased understanding about and prevalence of sleep disorders. One of those disorders, obstructive sleep apnea (OSA), is particularly common. It disproportionally affects veterans; up to 48% of them may have the disorder. Yet, despite improvements in OSA diagnosis and treatment, adherence to that treatment is poor and tools to enhance it remain elusive. There is a paucity of medical anthropological research identifying ecological and cultural factors that could lead to poor treatment adherence. To better understand differing adherence patterns in rural north Georgia veterans with OSA, we conducted quantitative and qualitative analyses based on standard questionnaires and phone interview scripts. Analysis of veterans’ narratives generated from those interviews identified key predictors of treatment adherence. Notably, more adherent patients reported higher satisfaction with life, slept longer, and were more likely to co-sleep with a bed partner compared to less adherent patients. These findings could help guide the development of more effective interventions to promote OSA treatment adherence.
Table of Contents
Introduction.............................................................................1
Research Questions
Chapter 1: Background and Literature Review.........................4
Obstructive Sleep Apnea (OSA)
Prevalence of OSA Among Veterans
Diagnosis and Treatment of OSA
The Advent of “Sleep Science” and the Medicalization of Sleep
Cultural Models of Sleep
Evolutionary Ecology of Human Sleep Sleep in the Military
Research Questions and Hypotheses
Chapter 2: Methodology..........................................................................25
Sampling and Sample Characteristics
Study Population and Recruitment
Questionnaire and Interview Script Development
Preliminary Research and IRB Approval
Ethical Considerations
Data Collection
Data Analysis
Thematic Analyses
Chapter 3: Results..................................................................................31
Quantitative Results
Demographic Information of Patient Participants
Self-Reported Measurements
Univariate and Multivariate Analyses
Qualitative Results
Psychological Effects
Barriers and Drivers for CPAP use
Chapter 4: Discussion and Limitations..........................................................53
Why the Presence/ Absence of Differences?
Limitations
Chapter 5: Conclusion and Future Directions................................................66
Conclusion
Future Directions
References.............................................................................................68
Appendix I.............................................................................................74
Department of Veterans Affairs Research Recruitment Form
Appendix II..........................................................................................75
Oral Consent Form
Appendix III..........................................................................................78
Interview Script
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