Electronic reminders and rewards to improve adherence to inhaled asthma treatment in adolescents: a non-randomised feasibility study in tertiary care

Abstract

ObjectiveTo test the feasibility and acceptability of a short-term reminder and incentives intervention in adolescents with low adherence to asthma medications.MethodsMixed-methods feasibility study in a tertiary care clinic. Adolescents recruited to a 24-week programme with three 8-weekly visits, receiving electronic reminders to prompt inhaled corticosteroid (ICS) inhalation through a mobile app coupled with electronic monitoring devices (EMD). From the second visit, monetary incentives based on adherence of ICS inhalation: £1 per dose, maximum £2 /day, up to £112/study, collected as gift cards at the third visit. End of study interviews and questionnaires assessing perceptions of asthma and ICS, analysed using the Perceptions and Practicalities Framework.ParticipantsAdolescents (11–18 years) with documented low ICS adherence (<80% by EMD), and poor asthma control at the first clinic visit.Results10 out of 12 adolescents approached were recruited (7 males, 3 females, 12–16 years). Eight participants provided adherence measures up to the fourth visits and received rewards. Mean study duration was 281 days, with 7/10 participants unable to attend their fourth visit due to COVID-19 lockdown. Only 3/10 participants managed to pair the app/EMD up to the fourth visit, which was associated with improved ICS adherence (from 0.51, SD 0.07 to 0.86, SD 0.05). Adherence did not change in adolescents unable to pair the app/EMD. The intervention was acceptable to participants and parents/guardians. Exit interviews showed that participants welcomed reminders and incentives, though expressed frustration with app/EMD technological difficulties. Participants stated the intervention helped through reminding ICS doses, promoting self-monitoring and increasing motivation to take inhalers.ConclusionsAn intervention using electronic reminders and incentives through an app coupled with an EMD was feasible and acceptable to adolescents with asthma. A pilot randomised controlled trial is warranted to better estimate the effect size on adherence, with improved technical support for the EMD.

Patient financial incentives to improve asthma management: a systematic review

“…As detailed in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart25 (see figure 1), searches identified 4268 articles; 8 met the eligibility criteria 26–33…”

Encouraging adherence in adolescents with asthma using financial incentives: An RCT

“…The first evaluated both gaming related incentives and financial incentives in a small population of minority adolescents, and found promising improvements in adherence and asthma control 16 . A more recently published pilot feasibility study showed potentially feasibility and acceptability of the intervention, 17 however there were significant technological challenges. Both studies recommended further randomized controlled trials of these incentive interventions.…”

“…While promising for various diseases in the adult population, financial incentives have been comparatively under‐studied in children. There have been two small single arm feasibility studies of financial incentives in adolescents with asthma, which indicated further evaluation was warranted with a randomized controlled trial 16,17 . We therefore designed a randomized controlled trial to evaluate the effect of a modest financial incentive on medication adherence in adolescents with asthma as measured by an electronic medication monitoring device (EMM).…”

“…There have been two small single arm feasibility studies of financial incentives in adolescents with asthma, which indicated further evaluation was warranted with a randomized controlled trial. 16,17 We therefore designed a randomized controlled trial to evaluate the effect of a modest financial incentive on medication adherence in adolescents with asthma as measured by an electronic medication monitoring device (EMM). Our primary hypothesis was that a modest financial incentive would be associated with increased medication adherence over a monitored control group among adolescents with asthma.…”

Effect of electronic reminders on patients’ compliance during clear aligner treatment: an interrupted time series study

“…In addition to sending e-feedback and e-reminders to patients on regular basis, financial incentives were reported to enhance patient compliance 38 . In the context of the mobile application, a gaming component could be considered to further optimize compliance 39 , 40 . The efficacy of these methods in CAT patients needs to be further studied.…”