Responsive Asthma Care for Teens (ReACT): development protocol for an adaptive mobile health intervention for adolescents with asthma

Abstract

IntroductionAsthma is a leading cause of youth morbidity in the USA, affecting >8% of youth. Adherence to inhaled corticosteroids (ICS) can prevent asthma-related morbidity; however, the typical adolescent with asthma takes fewer than 50% of their prescribed doses. Adolescents are uniquely vulnerable to suboptimal asthma self-management due to still-developing executive functioning capabilities that may impede consistent self-regulation and weaken attempts to use problem solving to overcome barriers to ICS adherence.Methods and analysisThe aims of this project are to improve adherence to ICS as an important step towards better self-management among adolescents aged 13–17 years diagnosed with asthma by merging the efficacious behaviour change strategies found in behavioural health interventions with scalable, adaptive mobile health (mHealth) technologies to create the Responsive Asthma Care for Teens programme (ReACT). ReACT intervention content will be developed through an iterative user-centred design process that includes conducting (1) one-on-one interviews with 20 teens with asthma; (2) crowdsourced feedback from a nationally representative panel of 100 adolescents with asthma and (3) an advisory board of youth with asthma, a paediatric pulmonologist and a behavioural health expert. In tandem, we will work with an existing technology vendor to programme ReACT algorithms to allow for tailored intervention delivery. We will conduct usability testing of an alpha version of ReACT with a sample of 20 target users to assess acceptability and usability of our mHealth intervention. Participants will complete a 4-week run-in period to monitor their adherence with all ReACT features turned off. Subsequently, participants will complete a 4-week intervention period with all ReACT features activated. The study started in October 2018 and is scheduled to conclude in late 2019.Ethics and disseminationInstitutional review board approval was obtained at the University of Kansas and the University of Florida. We will submit study findings for presentation at national research conferences that are well attended by a mix of psychologists, allied health professionals and physicians. We will publish study findings in peer-reviewed journals read by members of the psychology, nursing and pulmonary communities.

Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development

“…We combined all quotas for non-White participants into one group to allow for faster data collection after 2 months of recruitment. Please see our previous work for more detail about the recruitment procedures [23].…”

“…Interviews were 30-60 minutes and audiorecorded. Adolescents and their caregivers completed asthma-related questionnaires [23] in order to describe the sample and gather data on asthma-related and adherence-related constructs. Adolescent-caregiver dyads received US $60 as compensation for their participation.…”

“…Our immediate next steps are to conduct a pilot acceptability, usability, and preliminary efficacy study with target ReACT users [23]. Specifically, our pretest-posttest design will include a sample of 20 adolescents with persistent asthma.…”

“…Mobile health (mHealth) interventions have recently received considerable attention for improving adherence to ICS among youth [20,22]. Smartphones are a readily available intervention medium for youth with asthma given their ubiquitous nature across socioeconomic strata and habitual daily use by adolescents [23,24]. Furthermore, recent advances in ambulatory disease management technology (eg, medication sensors) have led to opportunities in mHealth for continuous passive monitoring to better identify and contextualize states of vulnerability for poor or declining disease self-management.…”

“…Our interdisciplinary team of behavioral health experts, pediatric pulmonologists, and technologists recently developed an adaptive mHealth adherence promotion intervention, Responsive Asthma Care for Teens (ReACT), that is grounded in self-regulation theory (SRT) [23]. ReACT is an integrated mHealth system that passively monitors adolescents' adherence to ICS using a novel Bluetooth-enabled sensor, developed in collaboration with the University of Kansas Instrumentation Design Laboratory, that attaches to ICS canisters.…”