Asthma is one of the most common chronic diseases worldwide, with a substantial proportion of the asthma population being children and adolescents. Self-management is recognized as a key component to asthma management, with multiple international guidelines emphasizing the need for adequate self-management skills for good asthma control. Unfortunately, the uptake amongst young people and adolescents is low, with often suboptimal engagement to self-management education and skills contributing to poor adherence to medication as well as poor perception of asthma symptoms. Innovative solutions to deliver education and self-management to adolescents are clearly needed. mHealth is the use of mobile devices such as smartphones and tablet devices to improve healthcare and has been used in multiple chronic diseases. This review articles explores the current use of mHealth in asthma, specifically smartphone and tablet applications as a generation-appropriate, accessible delivery modality for provision of asthma education and self-management interventions in adolescents. Current evidence gaps are also highlighted, which should be addressed in future research.

Asthma is a chronic inflammatory condition of the airways with a heterogenous symptom profile. When symptoms are poorly controlled and frequent, asthma sufferers are impacted regularly, with limitations on physical activities and sleep disturbances, significantly impairing quality of life. Asthma is highly prevalent and the leading cause of disease burden in young people. Those aged 0–14 contribute to over half of the asthma hospitalisations within Australia. Asthma education and self-management remains a key component of care; however, challenges remain in the paediatric population with difficulties of engagement. Augmented reality (AR) may provide a novel and effective solution with its ability to superimpose virtual objects into a real-world setting. Using a smartphone or tablet to deliver AR makes this modality accessible to much of the population. AR is a growing field in technology and has already established uses in education and training. The ability to increase motivation, enhance enjoyment and encourage faster concept understanding in the educational setting is encouraging and supports our proposal that AR technology can provide a generation appropriate education delivery modality for young people with asthma. To ensure successful implementation of an AR asthma educational resource on a large scale, the usability, acceptability, barriers and enablers of its use must be investigated. Using an iterative co-design process, an asthma resource utilising AR to deliver education on inhaler technique will be created. Qualitative research will be undertaken using semi-structured interviews with moderator guides to obtain mixed-method data on the AR resource. Participants will be key members of the asthma community including children and adolescents with asthma (8–17 years old), caregivers of children and adolescents with asthma, and health professionals. Understanding the usability, acceptability, barriers and enablers of the AR resource will enable us to improve our alpha version and test an optimal version in a planned feasibility study.

Background Inhaled medications or inhalers provide first-line pharmacotherapeutic treatment for patients with asthma for both acute symptomatic relief and long-term management to keep symptoms under control. A good technique requires only basic instruction and training; however, a recent study identified that 92% of children do not follow all correct steps when using inhalers. There is a growing interest in technology-enhanced asthma education, with evidence demonstrating improvements in knowledge and treatment adherence. Subsequently, there are calls to explore the role of technology-based solutions in improving asthma management and disease outcomes from public health experts, health professionals, and patients with asthma. Augmented reality (AR) technology is an information delivery mechanism with proven efficacy in educational settings. AR displays digital content in a real-world environment using the camera on a smartphone or tablet device to create an immersive learning experience. Objective The study aimed to evaluate the acceptability of AR as a mechanism for delivering asthma inhaler technique education from the perspective of children with asthma and their parents and health professionals, examined through the theoretical framework of acceptability (TFA). Methods An asthma education resource enhanced with AR technology was created to provide inhaler technique education to children. An iterative co-design process was undertaken with target end users for a qualitative evaluation. The participants were 8 to 12 years old with asthma, their caregivers, and health professionals who had experience in managing asthma. Qualitative data were obtained through semistructured one-on-one interviews. Deductive thematic analysis using TFA was undertaken using NVivo software 2020 to assess the acceptability of AR as a delivery modality for asthma inhaler technique education. Results Overall, 6 health care professionals, 5 asthmatic children, and 5 caregivers of children with asthma totaled a sample of 16. The use of AR in the asthma inhaler resource was found to be acceptable when responses were examined in accordance with TFA. Each of the 7 component constructs of TFA was coded throughout the 16 interviews, with perceived effectiveness (157 times) and affective attitude (63 times) coded most frequently. Positive responses included the intervention being accessible, easy to use, interesting, and fitting within the users’ value systems. Negative responses included the need to maintain an interest in children and concerns about the loss of face-to-face interaction with health professionals. Conclusions AR appears to be an acceptable modality for delivering asthma education to children when explored using TFA constructs. Although some challenges were identified with the use of AR, the results were predominantly positive. Future designs of asthma education interventions involving AR should consider the results of this study, and further research should focus on the feasibility, usability, and barriers and facilitators of behavior change to ensure the successful implementation and uptake of AR into clinical settings. International Registered Report Identifier (IRRID) RR2-10.1177/16094069211042229

Background Many people with asthma use incorrect inhaler technique, resulting in suboptimal disease management and increased health service use. Novel ways of delivering appropriate instructions are needed. Objective This study explored stakeholder perspectives on the potential use of augmented reality (AR) technology to improve asthma inhaler technique education. Methods On the basis of existing evidence and resources, an information poster displaying the images of 22 asthma inhaler devices was developed. Using AR technology via a free smartphone app, the poster launched video demonstrations of correct inhaler technique for each device. In total, 21 semistructured, one‐on‐one interviews with health professionals, people with asthma, and key community stakeholders were conducted, and data were analyzed thematically using the Triandis model of interpersonal behavior. Results A total of 21 participants were recruited into the study, and data saturation was achieved. People with asthma were confident with inhaler technique (mean score 9.17, SD 1.33, out of 10). However, health professionals and key community stakeholders identified that this perception was misguided (mean 7.25, SD 1.39, and mean 4.5, SD 0.71, for health professionals and key community stakeholders, respectively) and facilitates persistent incorrect inhaler use and suboptimal disease management. Delivering inhaler technique education using AR was favored by all participants (21/21, 100%), particularly around ease of use, with the ability to visually display inhaler techniques for each device. There was a strongly held belief that the technology has the capacity for improving inhaler technique across all participant groups (mean 9.25, SD 0.89, for participants; mean 9.83, SD 0.41, for health professionals; and mean 9.5, SD 0.71, for key community stakeholders). However, all participants (21/21, 100%) identified some barriers, particularly regarding access and appropriateness of AR for older people. Conclusions AR technology may be a novel means to address poor inhaler technique among certain cohorts of patients with asthma and serve as a prompt for health professionals to initiate review of inhaler devices. A randomized controlled trial design is needed to evaluate the efficacy of this technology for use in the clinical care setting.