The challenges and facilitators of self-management in pediatric asthma

Background Asthma is a common chronic pediatric disease that can negatively impact children and families. Self-management strategies are challenging to adopt but critical for achieving positive outcomes. Mobile health technology may facilitate self-management of pediatric asthma, especially as adolescents mature and assume responsibility for their disease. Objective This study aimed to explore the perceptions of youths with high-risk asthma and their caregivers on the use of a smartphone app, Smartphone Asthma Management System, in the prevention and treatment of asthma symptoms, possible use of the app to improve self-management of asthma outside traditional clinical settings, and the impact of asthma on everyday life to identify potential needs for future intervention development. Methods Key informant interviews were completed with parent-child dyads post participation in an asthma management feasibility intervention study to explore the perceptions of users on a smartphone app designed to monitor symptoms and medication use and offer synchronous and asynchronous provider encounters. A thematic qualitative analysis was conducted inductively through emergent findings and deductively based on the self-determination theory (SDT), identifying 4 major themes. Results A total of 19 parent-child dyads completed the postintervention interviews. The major themes identified included autonomy, competence, relatedness, and the impact of asthma on life. The participants also shared their perceptions of the benefits and challenges associated with using the app and in the self-management of asthma. Both children and parents conveyed a preference for using technology to facilitate medication and disease management, and children demonstrated a strong willingness and ability to actively engage in their care. Conclusions Our study included support for the app and demonstrated the feasibility of enhancing the self-management of asthma by youth in the community. Participant feedback led to intervention refinement and app improvements, and the use of the SDT allowed insight into motivational drivers of behavioral change. The use of mobile apps among high-risk children with asthma and their parents shows promise in improving self-management, medication adherence, and disease awareness and in reducing overall disease morbidity.

Download Full-text

The feasibility, efficacy and efficiency of eHealth-supported pediatric asthma care implemented in daily clinical practice: a 6-month proof of concept study. (Preprint)

10.2196/preprints.24634 ◽

2020 ◽

Author(s):

Mattienne Kamp ◽

Pamela Hartgerink ◽

Jean MM Driessen ◽

Boony Thio ◽

Hermie Hermens ◽

...

Keyword(s):

Health Care ◽

Clinical Practice ◽

Early Detection ◽

Asthma Control ◽

Cost Efficiency ◽

Pediatric Asthma ◽

Self Management ◽

Intention To Use ◽

Proof Of Concept ◽

Asthma Care

BACKGROUND Strategies aimed at the early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, revealing the most potential benefits in terms of adoption, efficiency and effectiveness. This may lay the foundation for targeted effectiveness studies with the lessons learned. OBJECTIVE The aim of this proof of concept study was to investigate the feasibility and explore the efficacy and cost-efficiency of an eHealth program implemented in daily clinical pediatric asthma practice. METHODS We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. Asthma control was monitored by objective home-measurements in the web-based Puffer-app to allow timely medical anticipation and prevent treatment delay. Children with moderate-to-severe asthma and a high medical consumption were asked to participate in the eHealth program for 6 months. The clinical feasibility was investigated by measures of participation and patient reported health and care outcomes. Moreover, the implementation experiences of the health care professionals (HCP’s) were evaluated in a focus group. Technical feasibility was investigated by measures of technology use, system usability and technology acceptance. The efficacy and cost-efficiency of the eHealth care were explored by comparing pre-post program differences in asthma outcomes (asthma control, lung function and therapy adherence) and medical consumption. RESULTS 35/41 children volunteered for participation, of which 30 finished the 6-month eHealth program. 75% of these children indicated that eHealth helped to control their asthma during the program. HCPs preferred making safe and substantiated medical decisions based on home measurements and real time communication with patients during symptoms. The Puffer-app scored highest on ease of use (77.1%) and intention to use (81.0%) and scored lowest on control over the system (64.4%) and enjoyment (65.6%). With an average patients’ time commitment of 15 minutes, eHealth care led to a 80% gross reduction in healthcare utilization, 8.6% increase (P =.40) in asthma control, 25.0% increase (P =.04) in the self-management level and a 20.4% improved (P =.02) therapy adherence. CONCLUSIONS Children and parents were eager to participate in the study, expressed a high intention to use the Puffer-app and indicated it was easy to work with. eHealth asthma care is feasible, enables safe remote care and is beneficial to the majority of asthmatic children in terms of health outcomes and health care utilization.

Download Full-text