Abstract
BackgroundUncontrolled asthma poses substantial negative personal and health system impacts. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes.ObjectiveThe aim of this study was to design, develop, and assess the utilization of an asthma collaborative self-management (CSM) platform (breathe) using content based on international evidence-based clinical guidelines.MethodsWe designed and developed breathe as a Web-based mobile health (mHealth) platform accessible on smartphones, tablets, or desktop with user-centered design methods and International Organization for Standardization–certified quality development processes. Moreover, breathe was envisioned as a multifunctional, CSM mHealth platform, with content based on international clinical practice guidelines and compliant with national privacy and security specifications. The system enabled CSM (patient, provider, and breathe) and self-monitoring of asthma patients through (1) assessment of asthma control, (2) real-time access to a dynamic asthma action plan, (3) access to real-time environmental conditions, and (4) risk-reduction messaging. The data collection protocol collected user data for 12 months, with clinic visits at baseline and 6 and 12 months. Utilization outcomes included user interactions with the platform, user impressions, self-reported medication use, asthma symptom profile, reported peak flow measurement, and the delivery and impact of email reminders.ResultsWe enrolled 138 patients with a mean age of 45.3 years to receive the breathe intervention. Majority were female (100/138, 72.5%), had a smartphone (92/138, 66.7%), and had a mean Asthma Control Test score of 18.3 (SD 4.9). A majority reported that breathe helped in the management of their asthma. Moreover, breathe scored 71.1 (SD 18.9) on the System Usability Scale. Overall, 123 patients had complete usage analytics datasets. The platform sent 7.96 reminder emails per patient per week (pppw), patients accessed breathe 3.08 times, journaled symptoms 2.56 times, reported medication usage 0.30 times, and reported peak flow measurements 0.92 times pppw. Furthermore, breathe calculated patients’ action plan zone of control 2.72 times pppw, with patients being in the green (well-controlled) zone in 47.71% (8300/17,396) of the total calculations. Usage analysis showed that 67.5% (83/123) of the participants used the app at week 4 and only 57.7% (71/123) by week 45. Physician visits, email reminders, and aged 50 years and above were associated with higher utilization.ConclusionsIndividuals with asthma reported good usability and high satisfaction levels, reacted to breathe notifications, and had confidence in the platform’s assessment of asthma control. Strong utilization was seen at the intervention’s initiation, followed by a rapid reduction in use. Patient reminders, physician visits, and being aged 50 years and above were associated with higher utilization.Trial RegistrationClinicalTrials.gov NCT01964469; https://clinicaltrials.gov/ct2/show/NCT01964469
Highlights
BackgroundAsthma is a common chronic disease that poses a serious global health problem
We used the Wilcoxon rank-sum Test to compare the number of weeks with at least one login during the 52 weeks between groups defined by age, college education, smartphone use, and baseline Asthma Control Test (ACT) score
Results mobile health (mHealth) Platform Architecture of breathe breathe is a Web-based mHealth platform that utilizes HTML5 and responsive design allowing a single version of the platform to be accessible on any device
Summary
BackgroundAsthma is a common chronic disease that poses a serious global health problem. A majority of patients prefer an active or collaborative role in their asthma management, in the context of an asthma exacerbation [15,16] Despite this strong evidence, these patient preferences, and consistent recommendations in international guidelines [11,12,13], CSM continues to be available to only a minority of patients (2%-11%) [5,17]. These patient preferences, and consistent recommendations in international guidelines [11,12,13], CSM continues to be available to only a minority of patients (2%-11%) [5,17] For these reasons, asthma is a chronic disease well suited for an examination of the transformative promise of smartphone mobile health (mHealth) apps in support of CSM. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes
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