Treatment Adherence Patterns in Rural Georgian Veterans with Sleep Apnea: An Anthropological Approach Restricted; Files Only

Hsieh, Sharon (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/6w924b815?locale=en
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Abstract

Treatment Adherence Patterns in Rural Georgian Veterans with Sleep Apnea: An Anthropological Approach

By: Sharon Hsieh

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

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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