Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Mar 19, 2020
Date Accepted: Apr 27, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Development, Content Validation and Testing of Tailored Motivational Messages for an mHealth Sleep Behavioral Change Support System to Promote CPAP Use among OSA Patients
ABSTRACT
Background:
Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment for obstructive sleep apnea (OSA). Despite the reported benefits of CPAP therapy in treating OSA, its effectiveness is reduced by less-than-optimal adherence/usage. Up to 50% of patients who accept using CPAP therapy fail to adhere to it. Because lack of commitment to a CPAP therapy is one of the most significant factors that hinders OSA treatment effectiveness, patient motivation and education are critical to help alleviate the problem of poor CPAP adherence/usage.
Objective:
The objective of this study was to support the development of mHealth interventions or information systems (IS) solutions to promote CPAP adherence/usage among OSA patients through development, content validation, and testing of tailored motivational messages.
Methods:
In phase 1, an initial library of 60 messages was developed to promote CPAP usage among OSA patients. In phase 2, draft messages were evaluated for content validation testing for relevance and clarity by research and clinical experts. In phase 3, OSA patients (N= 24) were recruited through a Qualtrics panel to rate the perceived persuasiveness of the messages, in terms of threat and efficacy perceptions, in accordance with their computed Extended Parallel Process Model (EPPM) response states. An average score of the ratings was calculated for each message. The messages were sorted according to their average (from highest to lowest) to select the best 12 messages for each tailored set, based on the EPPM potential responses.
Results:
In Phase 1, 60 messages were developed based on existing literature and a review of existing materials. In Phase 2, the enumerated content validity of the messages was established through the utilization of I-CVI. Fifty-seven messages were found to have acceptable content relevance and clarity. In Phase 3, OSA patients perceived the final library of 48 messages to be persuasive.
Conclusions:
After the process of content validation and testing, the final library of messages met the criteria for clarity, relevance, and perceived persuasiveness. This study emphasizes the importance of developing and validating the content of motivational messages, grounded in EPPM theory, across the four possible response states in terms of high/low efficacy and threat perceptions.
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