Evaluation of a web-based asthma self-management system: a randomised controlled pilot trial

Abstract

BackgroundAsthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children. Low rates of asthma preventer medication adherence is a major contributor to poor asthma control in these patients. Web-based methods have potential to improve patient knowledge and medication adherence by providing interactive patient education, monitoring of symptoms and medication use, and by facilitation of communication and teamwork among patients and health care providers. Few studies have evaluated web-based asthma support environments using all of these potentially beneficial interventions. The multidimensional website created for this study, BostonBreathes, was designed to intervene on multiple levels, and was evaluated in a pilot trial.MethodsAn interactive, engaging website for children with asthma was developed to promote adherence to asthma medications, provide a platform for teamwork between caregivers and patients, and to provide primary care providers with up-to-date symptom information and data on medication use. Fifty-eight (58) children primarily from inner city Boston with persistent-level asthma were randomised to either usual care or use of BostonBreathes. Subjects completed asthma education activities, and reported their symptoms and medication use. Primary care providers used a separate interface to monitor their patients’ website use, their reported symptoms and medication use, and were able to communicate online via a discussion board with their patients and with an asthma specialist.ResultsAfter 6-months, reported wheezing improved significantly in both intervention and control groups, and there were significant improvements in the intervention group only in night-time awakening and parental loss of sleep, but there were no significant differences between intervention and control groups in these measures. Emergency room or acute visits to a physician for asthma did not significantly change in either group. Among the subgroup of subjects with low controller medication adherence at baseline, adherence improved significantly only in the intervention group. Knowledge of the purpose of controller medicine increased significantly in the intervention group, a statistically significant improvement over the control group.ConclusionsThis pilot study suggests that a multidimensional web-based educational, monitoring, and communication platform may have positive influences on pediatric patients’ asthma-related knowledge and use of asthma preventer medications.

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.…”

“…Three studies measured adherence using electronic monitoring [52,60,61] while 2 used self-report [54,58]. All studies reported a significant positive effect of the intervention on adherence.…”

“…Seven studies (44%; all being RCTs) reported on health utilisation [50,51,[54][55][56][57]60]. All measured the number of emergency department visits or hospitalisations over a given time period.…”

“…Knowledge of Asthma Management Questionnaire [51]; a modified version of the Consumer Asthma Knowledge Questionnaire [62]; an Asthma Knowledge test [53]; Paediatric Asthma Care Knowledge Survey [56]; the Child Knowledge of Asthma Management Questionnaire [59], and three-open ended questions [59]; the Child/Adolescent Student Asthma Knowledge Questionnaire [64]; open-ended question format to assess knowledge of purpose of controller medication [60]; and The Asthma Information Quiz (AIQ) [65]. Six studies [51,56,60,62,64,65] found a significant positive effect of the intervention on asthma knowledge.…”

“…All studies reported a significant positive effect of the intervention on adherence. This included 4 RCTs [52,54,58,60] and the single pre-post study [61].…”