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Table 1 Intervention care content specified by behaviour change techniques and linked to constructs of the HAPA model

From: Intervention to enhance adherence to mandibular advancement appliance in patients with obstructive sleep apnoea: study protocol for a randomised clinical trial

Time
Point
Intervention component Behaviour change technique HAPA construct targeted Content
T(1) Pamphlet Information about consequences Risk perception and outcome expectancy The health pamphlet (Additional file 1), based on HAPA, divided into 6 sections, systematically provides information about the risk, benefits and treatment of OSA.
Section 2 and 4 of the pamphlets provides spaces for the participants to discuss about risks and benefits that concern them the most.
Section 3 explains the various treatments available and a brief explanation of the mechanism of the treatment.
Action planning Task self-efficacy Sections 5 and 6 provide valuable information for participants on how to begin with using the appliance and to continue using it regularly. Patients are advised that is normal to struggle at time when starting a new habit and setting short-term attainable goals will aid them in their struggles to adjust. The section suggests participants to seek feedback from their family, especially their sleeping partner regarding their improvement. This type of support motivates the patient to work more towards achieving their goals.
Goal setting
Problem-solving
Social support (unspecified)
Self-reward Coping and recovery self-efficacy In section 6, participants are told about the importance of rewarding themselves about the effort they put in to achieve their goals.
Relapse prevention Recovery self-efficacy Section 6 also advises the participants to focus on the positives and think about situations that effect their capability and then about options to avoid/cope with these situations.
T(1) Video Credible source Risk perception, outcome expectancy and task and coping self-efficacy Patients will be shown a video [50] of an OSA patients who are undergoing treatment, in order for them to relate to someone who is going through the same condition as him/her.
The video consists of patients talking about how OSA effected their life and its negative consequences.
The patients will also talk about what motivated them to start the treatment, how has it changed their life and what does they do to use the appliance regularly. It will also consist of a specialist in the field of OSA, briefly talking about the ill effects of untreated OSA and the specific oral appliance treatment available.
Social comparison
Information about the negative and positive consequences
Demonstration of behaviour
Feedback on the behaviour
Social support (emotional and practical)
T(1) Counselling Information about health consequences Risk perception, outcome expectancy and task self-efficacy Participants will be given an initial counselling session in person along with their partner if they wish. During the session i.e. structured to fit the participants needs…
• Their knowledge regarding OSA will be assessed
• The above video will be shown
• Using the information provided on the pamphlets the risks of untreated OSA and the benefits of the treatment will be discussed
• If the partner is present at the appointment, they will be asked to complete a section of the pre- screening questionnaire which is part of the routine clinical examination. In the questionnaire, the partner will also be asked to indicate their and the participant’s quality of sleep. In addition, the partner will also be asked to indicate the severity of the participant’s snoring and whether it has an influence on their sleep.
Social Support (unspecified and emotional)
Verbal persuasion about capability
T(2), T(3), T(4) and T(5) Follow up at sleep clinic Monitoring the behaviour and the outcome Coping and recovery self-efficacy Participants would be required to visit the sleep clinic for follow up at months 3 and 6. Their MAA usage will be assessed both objectively and subjectively by downloading the data from the micro-sensor chip embedded in the appliance and by recording the hours from their daily sleep log respectively.
Focus on past success and verbal persuasion about capability Coping and recovery self-efficacy Feedback would be provided depending on the participant’s usage. Their planning sheets would be discussed, and appropriate feedback will be provided whilst encouraging them to set more active goals and plans.
Social comparison Coping and recovery self-efficacy To increase their emotional support other patient’s feedbacks and successful treatment would be shared.
Problem-solving Coping and recovery self-efficacy Additionally, participants will be prompted to identify common factors that act as barriers for them in using the appliance and will be helped to find solutions to overcome such factors tailored to the participants needs.
3, 6, 18, and 21 weeks Booster phone calls Verbal persuasion about capability Coping and recovery self-efficacy Participants will receive calls at weeks 3, 6, 18 and 21 approximately 10–15 min in duration, prompting them to keep working towards their goals and stating that they are capable of achieving them.
Social support unspecified Coping and recovery self-efficacy Participant’s partner’s experience of the treatment will also be discussed by asking them to share their thoughts on the participant’s improvement.
Problem-solving Coping and recovery self-efficacy Additionally, participants will be prompted to identify common factors that act as barriers for them in using the appliance and will be helped to find solutions to overcome such factors tailored to the participants needs.