Mobile Technology Interventions for Asthma Self-Management: Systematic Review and Meta-Analysis

Abstract

BackgroundMobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes.ObjectiveA systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy.MethodsWe searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI.ResultsThe literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results.ConclusionsThis review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust studies to examine the effects of BCT use and engagement on MTI efficacy to inform the evidence base for MTI in individuals with asthma.

Theory-Based Digital Interventions to Improve Asthma Self-Management Outcomes: Systematic Review (Preprint)

“…This review identified 16 studies that evaluated 15 theory-based digital interventions in Previous systematic reviews have shown that digital self-management interventions can be effective at improving clinical outcomes in asthma [12,30,31], and suggest that theorybased interventions may be more effective than interventions that have not used theory in their development [44]. To our knowledge, this is the first systematic review to examine the extent to which theory has been applied to the development of digital self-management interventions for asthma.…”

“…Despite these benefits, adherence rates to asthma treatment remain low [12] and variable [13]. In general, 30-70% of people on long-term preventer therapy do not maintain the high levels of adherence necessary for good asthma control.…”

“…Recent systematic reviews have found that mobile technology interventions (mHealth) can significantly improve adherence in asthma when compared with standard treatment [12,30,31]. Miller et al [12] conducted a recent review and meta-analysis of mHealth interventions for the self-management of asthma comparing mHealth interventions with usual care, and found a moderate effect on adherence, a large effect on quality of life but no significant effect on lung function [12].…”

“…Miller et al [12] conducted a recent review and meta-analysis of mHealth interventions for the self-management of asthma comparing mHealth interventions with usual care, and found a moderate effect on adherence, a large effect on quality of life but no significant effect on lung function [12]. The authors also found mHealth interventions to be as effective as paper-based monitoring on adherence and clinical outcomes.…”

Web-Based Tailored Intervention to Support Optimal Medication Adherence Among Kidney Transplant Recipients: Pilot Parallel-Group Randomized Controlled Trial (Preprint)

“…In this regard, some researchers have suggested that technology could help improve and support medication adherence among kidney transplant recipients [4,7]. The use and added benefits of information and communication technologies (ICT) to support daily adherence in other patient suffering from chronic conditions, such as cardiovascular diseases, asthma or HIV, are well documented [8][9][10].…”