Testing the acceptability of an infographic to promote pediatric obstructive sleep apnea detection

(1) Develop and iteratively refine an infographic designed to promote obstructive sleep apnea activation in parents of symptomatic children; and (2) describe parental response to the infographic as implemented in clinical practice.

An infographic designed to activate parents to speak with their child's primary care provider about obstructive sleep apnea symptoms was developed using qualitative themes from parent interviews. To promote stakeholder acceptability of the infographic, we conducted 12 focus groups with parents (n = 24), primary care providers (n = 9), and sleep medicine physicians (n = 4) across three testing phases. For each iterative version, participants provided ratings on the infographic's clarity, activation, relevance, acceptability, feasibility, and accuracy. The infographic was then implemented in clinical practice across eight pediatric primary care clinics. A sample of parents whose child screened positive for obstructive sleep apnea (n = 148) viewed the infographic on a patient portal and were asked whether they planned to speak to their child's primary care provider about obstructive sleep apnea.

Stakeholder feedback yielded to revisions of the language, images, and text. Parents highly rated the infographic's final iteration for clarity (scale 1-5, M = 4.8, SD = 0.2), activation (M = 4.6, SD = 0.2), and relevance (M = 4.9, SD = 0.1). Primary care providers rated the infographic as highly acceptable (M = 4.7, SD = 0.5) and sleep medicine physicians highly rated the infographic as highly accurate (M = 5, SD = 0). When implemented in clinical care, almost half of parents who viewed the infographic (45.9%) reported intent to speak with their child's primary care provider about obstructive sleep apnea, with 36.5% reporting uncertainty and 17.6% indicating they did not plan to speak to their child's primary care provider.

We developed an infographic that can be applied across settings and may activate parents to speak with their child's provider about obstructive sleep apnea. The use of infographics and other parent-directed strategies can play an important role in obstructive sleep apnea detection.