Developing a Virtual Teach-To-Goal™ Inhaler Technique Learning Module: A Mixed Methods Approach

Abstract

Background Most hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD) misuse respiratory inhalers. An in-person educational strategy, teach-to-goal (TTG), improves inpatients’ inhaler technique. Objective To develop an effective, portable education intervention that remains accessible to hospitalized patients post-discharge for reinforcement of proper inhaler technique. Methods A mixed methods approach at an urban academic hospital was used to iteratively develop, modify and test a virtual teach-to-goal™ (V-TTG™) educational intervention using patient end-user feedback. A survey examined access and willingness to use technology for self-management education. Focus groups evaluated patients’ feedback on V-TTG™’s access, functionality, and quality. Results Forty-eight participants completed the survey with most reporting having internet access; 77% used the internet at home and 82% used the internet at least once every few weeks. Over 80% reported they were somewhat or very likely to use V-TTG™ to gain skills to improve their health. Most participants reported smart phone access (73%); half owned laptop computers (52%). Participants with asthma versus COPD were more likely to own a smartphone, have a data plan, and have daily internet use (p<0.05). Nine focus groups (n=25) identified themes for each domain: access--platform and delivery, internet access, and technological literacy; functionality--usefulness, content, and teaching strategy; and quality-- clarity, ease of use, length, and likability. Conclusion V-TTG™ is a promising educational tool for improving patients’ inhaler technique, iteratively developed and refined with patient input. Patients in our urban, academic hospital overwhelmingly reported access to platforms and willingness to use V-TTG™ for health education. Primary Funding National Heart Lung and Blood Institute (NIH K23HL118151).

Effectiveness of Virtual vs In-Person Inhaler Education for Hospitalized Patients With Obstructive Lung Disease

“…10,23 Screenshots of the V-TTG intervention were also published previously (eFigure 2 in Supplement 2). 24,25 Participants assigned to V-TTG were provided with a tablet device to complete the intervention, which consisted of self-assessment questions before demonstration, narrated video demonstration of correct technique, and self-assessment questions after demonstration; cycles of the narrated demonstration and self-assessment questions were repeated, as needed, until all questions were answered correctly or 3 rounds were completed. 10,23…”

“…A direct-to-patient, technology-based intervention designed to be a low-cost, feasible solution was developed by members of our team at the University of Chicago, some of whom are authors on this report; this intervention is housed and licensed on the Smart Sparrow platform. 24,25 However, it is unknown whether this virtual educational intervention is as effective as in-person education. Our primary objective was to test whether this virtual intervention was as effective as in-person education for improving inhaler technique among patients hospitalized with COPD.…”

Implementation of a Children's Safe Asthma Discharge Care Pathway Reduces the Risk of Future Asthma Attacks in Children–A Retrospective Quality Improvement Report

“…Finally, the recent Coronavirus (COVIT-19) pandemic has accelerated the use of Tele-Medicine as lockdowns and mandates meant that families and staff were less keen on face to face clinical meetings unless they were absolutely essential. While we believe face-to-face training is optimal it has been reported that inhaler instruction using the Teach-to-goal/Teach back technique is eminently possible via remote video consultation ( 28 ). Our SADCP therefore would lend itself to hybrid approaches with perhaps the first clinical assessment being face-to-face followed by some video consultations.…”

The Relationship Between Insufficient Vision and Technology Access and Use Among Hospitalized Adults at an Urban Academic Hospital: Observational Study

“…Participants were asked to read the row of words from left-to-right when measuring visual acuity in the right eye and right-to-left when measuring visual acuity in the left eye starting with the largest font first. Data were collected and managed using REDCap version 11.1.7 (Vanderbilt University) [ 12 ].…”