Synchrony-Optimized Non-Invasive Ventilation Education Program and ICU Patients

Adherence data, including daily NIV usage, will be retrieved from the NIV machine. Adherence will be defined as more than 4 hours of nighttime use for more than 70% of days until study completion or a mean daily use of more than 5 hours.

Levels of anxiety and depression will be assessed using the Hospital Anxiety and Depression Scale (HADS), a 14-item self-report instrument divided into two subscales: anxiety (HADS-A) and depression (HADS-D), each comprising seven items. Participants will rate each item on a 4-point scale (0-3), yielding subscale scores ranging from 0 to 21. Scores for both subscales will be interpreted as follows: 0-7 indicating no symptoms, 8-10 mild, 11-14 moderate, and 15-21 severe. The internal consistency of the anxiety subscale (HADS-A) and depression subscale (HADS-D) will have been demonstrated with Cronbach's alpha coefficients of 0.820 and 0.807, respectively. The Persian version of the HADS will have shown good reliability and validity in clinical populations. Montazeri et al. (2003) will have found it acceptable by 99% of patients, with Cronbach's alpha of 0.78 for anxiety and 0.86 for depression subscales.

Respiratory Symptoms, Sleep Quality, and NIV-Associated Adverse Events The S3-NIV Questionnaire will be a self-administered tool that includes 11 questions, all scored by patients on a 5-point Likert scale that ranges from 0 to 4 (0 = always true; 1 = mostly true; 2 = sometimes true; 3 = mostly untrue; 4 = completely untrue), based on their experiences over the previous four weeks. To calculate the overall score, the average of all completed items will be multiplied by 2.5. A score of zero will reflect the highest degree of disease impact, whereas a score of ten will reflect the lowest. Two subscale scores may also be derived: the "Respiratory Symptoms" sub score will be computed by averaging responses to items 1, 4, 5, 6, and 7 and multiplying by 2.5, while the "Sleep & Side Effects" sub score will be based on the average of items 2, 3, 8, 9, 10, and 11, also multiplied by 2.5.

To evaluate participants' comfort levels, the Visual Analog Scale (VAS) will be employed. The VAS will be a widely used, reliable, and sensitive instrument for assessing subjective experiences such as comfort (6). It typically will consist of a 10-centimeter horizontal line anchored by two extremes, for example, "no discomfort" on the left end (score 0) and "worst possible discomfort" on the right end (score 10). Participants will mark a point along the line that best represents their perceived level of comfort. The simplicity, sensitivity, and ease of administration of the VAS will make it a preferred tool in both clinical and research settings for quantifying subjective states.