Effect of a mHealth intervention on adherence in adolescents with asthma: A randomized controlled trial

Abstract

Background: Adherence rates among asthma patients are generally low and decrease during adolescence, resulting in poorly controlled asthma. The aim of our study was to evaluate the effectiveness of the ADolescent Adherence Patient Tool (ADAPT), an interactive mobile health (mHealth) intervention, in supporting selfmanagement and improving inhaled corticosteroid adherence in adolescents with asthma. Methods: We conducted a cluster randomized controlled trial in 66 Dutch community pharmacies. Asthma patients aged 12-18 years were invited to participate, based on pharmacy medication refill records. The main study outcome was self-reported medication adherence, measured with the Medication Adherence Report Scale (MARS). Secondary outcomes were asthma control and quality of life. Outcomes were measured at start (t = 0 months) and at the end of follow-up (t = 6 months). Mixed-effects models were used to analyze the effect. Results: In total, 234 adolescents (147 in the control group and 87 in the intervention group) completed the study; mean age 15.1 ± 1.9 years and 52.6% females. Adherence rates of patients with low baseline adherence (MARS scores ≤19; n = 76) increased with 1.42 points in the intervention group (n = 26). Adherence rates of patients in the control group (n = 50) decreased with 0.70 points. Thus there was a positive effect of the intervention on medication adherence (MARS +2.12, p = 0.04). This effect was stronger (MARS +2.52, p = 0.02) in poor adherent adolescents with uncontrolled asthma (n = 74). No effect of the intervention was observed on asthma control or quality of life. Conclusions: The ADAPT intervention increases medication adherence in adolescents with asthma having poor adherence rates at baseline. Healthcare providers should consider a tailored mHealth approach to improve the asthma treatment.

A Systematic Review of Randomized Controlled Trials of Telehealth and Digital Technology Use by Community Pharmacists to Improve Public Health

“…The search process is outlined in Figure 1 and the studies used as part of the review are summarized in Table 1 . The studies were conducted around the world, including the USA (n = 7), [ 46 , 47 , 48 , 49 , 50 , 51 , 52 ] the UK (n = 1) [ 53 ], Australia (n = 1) [ 54 ], the Netherlands (n = 3) [ 55 , 56 , 57 ], and Canada (n = 1) [ 58 ]. Public health topics addressed in the studies included vaccination rates [ 46 , 47 ], smoking cessation [ 54 ], medication adherence [ 48 , 49 , 52 , 53 , 55 , 57 , 58 ], medication counseling [ 56 ], and hypertension management [ 50 , 51 ].…”

“…The studies were conducted around the world, including the USA (n = 7), [ 46 , 47 , 48 , 49 , 50 , 51 , 52 ] the UK (n = 1) [ 53 ], Australia (n = 1) [ 54 ], the Netherlands (n = 3) [ 55 , 56 , 57 ], and Canada (n = 1) [ 58 ]. Public health topics addressed in the studies included vaccination rates [ 46 , 47 ], smoking cessation [ 54 ], medication adherence [ 48 , 49 , 52 , 53 , 55 , 57 , 58 ], medication counseling [ 56 ], and hypertension management [ 50 , 51 ]. The majority of the studies used telephones as their intervention tool [ 46 , 47 , 48 , 49 , 52 , 53 , 56 , 57 , 58 ] while only one study used an mHealth app [ 55 ], two studies used a tele-monitoring device [ 50 , 51 ] and one study used photo-aging software [ 54 ].…”

“…Public health topics addressed in the studies included vaccination rates [ 46 , 47 ], smoking cessation [ 54 ], medication adherence [ 48 , 49 , 52 , 53 , 55 , 57 , 58 ], medication counseling [ 56 ], and hypertension management [ 50 , 51 ]. The majority of the studies used telephones as their intervention tool [ 46 , 47 , 48 , 49 , 52 , 53 , 56 , 57 , 58 ] while only one study used an mHealth app [ 55 ], two studies used a tele-monitoring device [ 50 , 51 ] and one study used photo-aging software [ 54 ]. Despite smartphones now including video conferencing features, none of the reviewed studies employed this technology.…”

Asthma control and quality of life in adolescents: The role of illness perceptions, medication beliefs, and adherence

“…In this cross-sectional exploratory study, we used baseline data of patients who participated in the ADolescent Adherence Patient Tool (ADAPT) study, a randomized controlled trial to evaluate the effectiveness of a mobile health intervention on medication adherence. The complete rationale and design of the ADAPT study are described elsewhere (22,23). In short: adolescents aged 12-18 years who filled two or more prescriptions for ICS or a fixed combination of ICS with a long-acting beta-agonist (ICS/LABA) during the previous 12 months (defined as asthma patients) (24) were recruited by mail from community pharmacies belonging to the Utrecht Pharmacy Practice network for Education and Research (UPPER) (25).…”

Mobile Technology in Allergic Rhinitis: Evolution in Management or Revolution in Health and Care?

“…The automatic detection of progression of use of the liquid in the vial using computer vision may be of special relevance for sublingual allergen immunotherapy for which adherence can be a major issue (81). Other approaches already being tested for asthma but not for AR are mobile direct observation of therapy (82) and multicomponent interventions based on mobile technologies (83). Although there are already some mHealth apps for AR, there are few studies evaluating their benefits and impact (76).…”