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The Health Belief Model and Compliance with CPAP Treatment for Obstructive Sleep Apnoea

  • Claire E. Sage (a1), Anne-Marie Southcott (a2) and Stephen L. Brown (a3)


Obstructive sleep apnoea (OSA) is a disorder that severely disrupts sleep and may lead to severe long- and short-term health consequences. Continuous positive airway pressure (CPAP) is an effective treatment for OSA, but compliance with CPAP is often poor. Forty participants diagnosed with OSA completed a questionnaire based on the health belief model after a one-night first-time trial of CPAP treatment. After a subsequent 1-month period of CPAP use, electronic usage records were downloaded and analysed. Perceived benefits of CPAP use and perceived barriers to use showed multivariate associations with the mean number of hours of daily CPAP use, and perceived benefits of CPAP use was inversely associated with the percentage of days that CPAP was not used. Participants' confidence in their ability to use CPAP showed significant univariate, but not multivariate, relationships with both variables. Findings suggest that patients may benefit from greater levels of information and instruction in CPAP use.


Corresponding author

*Address for correspondence: Stephen L. Brown, Department of Psychology, University of Central Lancashire, Preston, PRI 2HE, United Kingdom. Email:


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Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. New Jersey: Prentice-Hall.
Barnhoorn, F., & Adriaanse, H. (1992). In search of factors responsible for noncompliance among tuberculosis patients in Wardha District, India. Social Science and Medicine, 34, 291306.
Bearpark, H., Elliot, L., & Grunstein, R. (1993). Occurrence and correlates of sleep disordered breathing in the Australian town of Bussleton: A preliminary analysis. Sleep, 16, S35.
Berry, R.B., & Block, A.J. (1984). Positive nasal airway pressure eliminates snoring as well as obstructive sleep apnea. Chest, 85(1), 1520.
Bond, G.G., Aiken, L.S., & Somerville, S.C. (1992). The health belief model and adolescents with insulin-dependent diabetes mellitus. Health Psychology, 11, 9098.
Brownlee-Duffeck, M., Peterson, L., Simonds, J.F., Goldstein, D., Kilo, C., & Hoette, S. (1987). The role of health beliefs in the regimen adherence and metabolic control of adolescents and adults with diabetes mellitus. Journal of Consulting and Clinical Psychology, 55, 139144.
Cerkoney, K.A.B., & Hart, L.K. (1980). The Relationship between the Health Belief Model and compliance of persons with Diabetes Mellitus. Diabetes Care, 3, 594598.
Chervin, R.D., Theut, S., Bassetti, C., & Aldrich, M.S. (1997). Compliance with nasal CPAP can be improved by simple interventions. Sleep, 20, 284289.
Cummings, K.M., Becker, M.H., Kirscht, J.P., & Levin, N.W. (1982). Psychosocial factors affecting adherence to medical regimens in a group of hemodialysis patients. Medical Care, 20, 567580.
Detweiler, J.B., Bedell, B.T., Salovey, P., Pronin, E., & Rothman, A. J. (1999). Message framing and sunscreen use: Gain-framed messages motivate beachgoers. Health Psychology, 18, 189196.
Dyken, M.E., Somers, V.K., Yamanda, T., Ren, Z., & Zimmerman, M. (1996). Investigating the relationship between stroke and obstructive sleep apnea. Stroke, 27, 401407.
Engleman, H.M., Martin, S.E., Deary, I.J., & Douglas, N.J. (1994). Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. The Lancet, 343, 572575.
Findley, L.J., Levinson, M.P., & Bonnie, R.J. (1992). Driving performance and automobile accidents in patients with sleep apnea. Clinics in Chest Medicine, 13(3), 427435.
Findley, L., Smith, C., Hooper, J., Dineen, M., & Suratt, P.M. (2000). Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea. American Journal of Respiratory and Critical Care Medicine, 161, 857859.
Guilleminault, C. (1994). Clinical features and evaluation of obstructive sleep apnea. In M.H., Kryger, T., Roth, & W.C., Dement (Eds.), Principles and practice of sleep medicine (2nd ed., pp. 667677). Philadelphia: W.B., Saunders.
Harris, R., & Linn, M.W. (1985). Health beliefs, compliance, and control of Diabetes Mellitus. Southern Medical Journal, 78, 162166.
Hoffstein, V., Viner, S., Mateika, S., & Conway, J. (1992). Treatment of obstructive sleep apnea with nasal continuous positive airway pressure: Patient compliance, perception of benefits, and side effects. American Review of Respiratory Disease, 145, 841845.
Hughes, I., Hill, B., & Budd, R. (1997). Compliance with antipsychotic medication: From theory to practice. Journal of Mental Health, 6, 473489.
Hung, J., Whitford, E.G., Parsons, R.W., & Hillman, D.R. (1990). Association of sleep apnoea with myocardial infarction in men. The Lancet, 336, 261264.
Issa, F.G., & Sullivan, C.E. (1986). The immediate effects of nasal continuous positive airway pressure treatment on sleep pattern in patients with obstructive sleep apnoea syndrome. Electroencephalography and Clinical Neurophysiology, 63, 1017.
Janz, N.K., & Becker, M.H. (1984). The Health Belief Model: A decade later. Health Education Quartley, 11, 147.
Kelly, G.R., Mamon, J.A., & Scott, J.E. (1987). Utility of the health belief model in examining medication compliance among psychiatric outpatients. Social Science and Medicine, 25, 12051211.
Kloeblen, A.S., & Batish, S.S. (1999). Understanding the intention to permanently follow a high folate diet among a sample of low-income pregnant women according to the health belief model. Health Education Research, 14, 327338.
Kribbs, N.B., Pack, A.I., Kline, L.R., Smith, P.L., Schwartz, A.R., Schubert, N.M., Redline, S., Henry, J.N., Getsy, J.E., & Dinges, D.F. (1993). Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnoea. American Review of Respiratory Disease, 147, 887895.
Kryger, M.H., Roth, T., & Dement, W.C. (Eds.). (1994). Principles and practice of sleep medicine (2nd Ed.) (pp. 694705). Philadelphia: W.B., Saunders.
Oldridge, N.B., & Steiner, D.L. (1990). The health belief model: Predicting compliance and dropout in cardiac rehabilitation. Medicine and Science in Sports and Exercise, 22, 678683.
O’Leary, A. (1985). Self-efficacy and health. Behaviour Research and Therapy, 23, 437451.
Owen, N., & Brown, S.L. (1991). Smokers unlikely to quit. Journal of Behavioral Medicine, 14, 625634.
Owen, N., Wakefield, M., Roberts, L., & Esterman, A. (1992). Stages of readiness to quit smoking: Population prevalence and correlates. Health Psychology, 11, 413417.
Pépin, J.L., Krieger, J., Rodenstein, D., Cornette, A., Sforza, E., Delguste, P., Deschaux, C., Griller, V., & Lévy, P. (1999). Effective compliance during the first 3 months of continuous positive airway pressure. American Journal of Respiratory Critical Care Medicine, 160, 11241129.
Pressman, M.R., Schetman, W.R., Figueroa, W.G., Van Uitert, B., Caplan, H.J., & Peterson, D.D. (1995). Transient ischemic attacks and minor stroke during sleep: Relationship to obstructive sleep apnoea syndrome. Stroke, 26, 23612365.
Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G., Markus, B.H., & Rakowski W. (1994). Stages of change and decisional balance for twelve problem behaviours. Health Psychology, 13, 3946.
Reeves-Hoche, M.K., Meck, R., & Zwillich, C.W. (1994). Nasal CPAP: An objective evaluation of patient compliance. American Journal of Respiratory Critical Care Medicine, 149, 149154.
Rolfe, I., Olson, L.G., & Saunders, N.A. (1991). Longterm acceptance of continuous positive airway pressure in obstructive sleep apnoea. American Review of Respiratory Disease, 144, 11301133.
Rosenstock, I.M. (1966). Why people use health services. Millbank Memorial Fund Quarterly, 44, 94127.
Rosenstock, I.M., Strecher, V.J., & Becker, M.H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15, 175183.
Schwarzer, R., & Fuchs, R.(1996). Self-efficacy and health behaviours. In M., Conner & P., Norman (Eds), Predicting health behaviour: Research and practice with social cognition models (pp. 163196). Buckingham, UK: Open University Press.
Silverberg, D.S., Oksenberg, A., & Iaina, A. (1998). Sleep-related breathing disorders as a major cause of essential hypertension: Fact or fiction? Current Opinion in Nephrology and Hypertension, 7, 353357.
Strollo, P.J., Jr., & Sanders, M.H. (1993). Significance and treatment of nonapneic snoring. Sleep, 16, 403408.
Sullivan, C.E., Issa, F.G., Berthon-Jones, M., & Eves, L. (1981). Reversal of obstructive sleep apnoea by continuous positive pressure applied through the nares. The Lancet, 18(1), 862865.
Sullivan, C.E., & Grunstein, R. (1994). Continuous positive airway pressure in sleep-disordered breathing. In M.H., Kryger, T., Roth, & W.C., Dement (Eds.), Principles and practice of sleep medicine (2nd Ed.) (pp, 694705). Philadelphia: W.B., Saunders Company.
Walhorn, R.E., Herrick, T.W., Nguyen, M.C., O’Donnell, A.E., Sodero, J., & Potolicchio, S.J. (1990). Longterm compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea. Chest, 97, 3338.
Weinstein, N.D. (1980). Unrealistic optimism about future life events. Journal of Personality and Social Psychology, 39, 805820.
Weinstein, N.D., & Klein, W.M. (1996). Unrealistic optimism: Present and future. Journal of Social and Clinical Psychology, 15, 18.


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