“Why Didn’t it Work?” Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults with Asthma

Abstract

BackgroundPersonally controlled health management systems (PCHMS), which may include a personal health record (PHR), health management tools, and information resources, have been advocated as a next-generation technology to improve health behaviors and outcomes. There have been successful trials of PCHMS in various health settings. However, there is mixed evidence for whether consumers will use these systems over the long term and whether they ultimately lead to improved health outcomes and behaviors.ObjectiveThe aim was to test whether use of a PCHMS by consumers can increase the uptake or updating of a written asthma action plan (AAP) among adults with asthma.MethodsA 12-month parallel 2-group randomized controlled trial was conducted. Participants living with asthma were recruited nationally in Australia between April and August 2013, and randomized 1:1 to either the PCHMS group or control group (online static educational content). The primary outcome measure was possession of an up-to-date written AAP poststudy. Secondary measures included (1) utilizing the AAP; (2) planned or unplanned visits to a health care professional for asthma-related concerns; (3) severe asthma exacerbation, inadequately controlled asthma, or worsening of asthma that required a change in treatment; and (4) number of days lost from work or study due to asthma. Ancillary analyses examined reasons for adoption or nonadoption of the intervention. Outcome measures were collected by online questionnaire prestudy, monthly, and poststudy.ResultsA total of 330 eligible participants were randomized into 1 of 2 arms (intervention: n=154; control: n=176). Access to the PCHMS was not associated with a significant difference in any of the primary or secondary outcomes. Most participants (80.5%, 124/154) did not access the intervention or accessed it only once.ConclusionsDespite the intervention being effective in other preventive care settings, system use was negligible and outcome changes were not seen as a result. Consumers must perceive the need for assistance with a task and assign priority to the task supported by the eHealth intervention. Additionally, the cost of adopting the intervention (eg, additional effort, time spent learning the new system) must be lower than the benefit. Otherwise, there is high risk consumers will not adopt the eHealth intervention.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite® at http://www.webcitation.org/6dMV6hg4A)

Theory-Based Digital Interventions to Improve Asthma Self-Management Outcomes: Systematic Review (Preprint)

“…1). Of these 16 studies, 11 (69%) reported on randomised controlled trials (RCT) (10 two-arm RCTs [50][51][52][53][54][55][56][57][58][59], one three-arm RCT [60]) and 5 (31%) were feasibility studies employing a pre-post design [61][62][63][64][65] (Multimedia Apendix 2). Two of the RCTs reported on the same intervention [51,59], however, as they reported on different outcomes, and different uses of theory, we have considered them as separate interventions.…”

“…Most studies were undertaken in the United States (75%; n=12; [51-56, 59-61, 63-65]), followed by Australia (n=2; [57,62]), Canada (n=1; [50]) and New Zealand (n=1; [58]). Studies included a range of ages: children (44%; n=7; [51, 53, 59-61, 64, 65]), adolescents (13%; n=2; [54,55]), adults (38%; n=6; [50,52,57,58,62,63]) and mixed sample (6%; n=1; [56]). Between 35-82% of the samples were female.…”

“…Table 2 shows the study characteristics in terms of adherence and self-management (including self-management efficacy, beliefs and behaviours) outcomes. Five studies (31%) did not report on behavioural outcomes [50,53,55,57,63].…”

“…Each of the five studies (31%; 3 RCTs and 2 pre-post studies) that measured self-management behaviour [51,57,59,62,64] used a different measure. These included the Partners in Health Scale [62], a validated measure of self-management behaviours, the Child Self-Management Instrument [51], Child Self-Efficacy Expectations measure [51], the use of writen action plans for managing asthma [57], the Asthma Belief Survey [64] and a 23-item questionnaire developed for the study to determine change in confidence in performing self-regulatory and asthma-specific behaviours, and an atribution classification questionnaire assessing self-management [59]. Three studies (3 RCTs and 1 pre-post study) reported a significant positive effect of the intervention on self-management behaviours [51,59,64] (Table 2).…”

“…Five studies (31%; 3 RCTs and 2 pre-post studies) reported on asthma control, measured by the Asthma Control Questionnaire (ACQ) (n=1; [57]); the Asthma Control Test (n=3; [50,52,63]); and the Royal College of Physicians 3-questions screening tool (n=1; [62]). Only the two pre-post studies [62,63] reported a significant effect of the intervention on asthma control.…”