Determining the factors affecting the compliance rate in the use of CPAP/BPAP devices: A mixed method application

The primary objective of this study is to comprehensively identify the factors influencing adherence to CPAP (Continuous Positive Airway Pressure) and BPAP (Bilevel Positive Airway Pressure) devices, which constitute the first-line treatment for Obstructive Sleep Apnea (OSA), and to compile an extensive list of variables—some of which have not previously been reported in the literature. Employing a mixed-methods design, the study analyzed data from patients treated at a university hospital-affiliated sleep center between 2018 and July 1, 2023. Quantitative data were obtained through structured surveys administered to 449 patients, while qualitative data were derived from in-depth interviews with 30 patients and document analysis of 449 patient records. Data analysis was conducted using FACTOR Analysis, SmartPLS, IBM SPSS, and MAXQDA software. The integration of quantitative and qualitative findings revealed a broad spectrum of multidimensional factors influencing CPAP/BPAP adherence, spanning device- and accessory-related, individual, psychosocial, environmental, regional, socio-political, and cultural domains. The study identified eight novel variables that had not been previously documented in the literature. These included barriers such as fear of lightning/thunderstorms, fear of earthquakes, relocation, religious practices, air pollution, and long hair, along with facilitators like the use of automatic devices and rural residency. The results demonstrate that current theoretical frameworks are inadequate in fully explaining CPAP/BPAP adherence, highlighting the complex and multifactorial nature of the process. This research emphasizes that adherence to CPAP/BPAP therapy cannot be fully understood through individual or technical factors alone; instead, geographical, cultural, religious, and environmental contexts must also be considered. The findings call for the development of new theoretical models and offer evidence-based, practical recommendations for healthcare providers, policymakers, and medical device manufacturers aiming to improve adherence rates.