Technology-Assisted Stepped-Care to Promote Adherence in Adolescents with Asthma: A Pilot Study

Abstract

To examine the feasibility, acceptability, and preliminary efficacy of a technology-assisted stepped-care behavioral intervention to improve adherence in adolescents with asthma. Thirty adolescents (M age = 14.66, 53% male) with moderate to severe-persistent asthma completed daily adherence monitoring and medication reminders via a mobile app (Step 1). Participants with < 68% adherence during Step 1 received a telehealth behavioral intervention (Step 2). Twenty-six of 30 participants (87%) completed Step 1. Step 2 was indicated for 18 participants and was completed by 17. Participants favorably rated their experience in the study. Improvements in adherence (40–58%, p = .048) and decreases in asthma composite severity scores (CASI 6.08–5.08, p = .023) were observed for the full sample. Technology-assisted stepped-care is feasible and acceptable. Participants demonstrated improved adherence and asthma composite severity scores once they received the appropriate step of the intervention. Future studies should include a control group, a longer time-frame and an intermediate intervention step.

Telehealth interventions for transition to self‐management in adolescents with allergic conditions: A systematic review

“…Many interventions included a monitoring aspect ( n = 7), such as the recording of medications taken, peak flow readings or symptom questionnaires. Two studies used an electronic monitoring device (EMD) that attaches onto an inhaler, to monitor adherence in real time, 54,56 with one of these 56 also using mobile spirometry to monitor lung function. All interventions ( n = 15) featured behavioural content, mainly technique skill in administering medications such as inhalers or adrenaline auto‐injectors and adherence promotion.…”

“…Feasibility overall was enhanced by convenience to users, for example, ‘Teen Talks’ was delivered at 6 PM on a weekend day to accommodate adolescents' school and activities 48 . Enrolment rates varied widely, with 94% of those eligible recruited to a mobile application and video‐conferencing intervention, which may speak to its perceived benefit 56 . On the contrary, some studies had poor enrolment, with reasons given as lack of interest or not taking daily asthma medication anymore, 61 and large numbers who did not answer calls or return messages 51 .…”

“…Both Lin et al 54 . and Ramsey et al 56 . reported participants attended 100% of ‘self‐management’ or ‘behavioural’ telehealth visits, which were one‐to‐one live video‐conferencing visits with HCPs.…”

“…The term 'transition' was only used explicitly in three articles (Table 1), but was referred to implicitly by most. For example, Ramsey et al 56 did not use the term in their article, but the content of their behavioural sessions included the allocation of treatment responsibility between the adolescent and parents. However, 12 articles referred to self-management explicitly, highlighting the widespread recognition of this concept.…”

“…56 On the contrary, some studies had poor enrolment, with reasons given as lack of interest or not taking daily asthma medication anymore, 61 and large numbers who did not answer calls or return messages. 51 Some studies provided Internet 49,56 or devices such as smartphones, 50,54,56 EMDs 54,56 or peak flow meters 58 to participants. While the cost of providing these resources to participants were not reported, it would likely not be feasible for most services to offer this to every patient as part of a standard intervention.…”