Abstract
BackgroundAdolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents’ objectively measured ICS adherence data indicate suboptimal rates of medication use.ObjectiveThe current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content.MethodsWe developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17–year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development.ResultsConsistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow).ConclusionsReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT’s emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process.
Highlights
What Is Asthma?Asthma is a common chronic disorder of the airways characterized by periods of reversible airflow obstruction known as asthma episodes or attacks.[4,5] Asthma attacks are caused by chronically hyperactive and inflamed airways, leading to airflow obstruction.[5]
Asthma Facts – Centers for Disease Control and Prevention (CDC)’s National Asthma Control Program Grantees is a report produced by the CDC National Asthma Control Program (NACP) that describes asthma prevalence, healthcare utilization, asthma self-management education, and mortality for the program’s funded grantees in 34 states, the District of Columbia, and Puerto Rico
Current asthma prevalence varied among age, sex, and racial/ethnic groups
Summary
Asthma is a common chronic disorder of the airways characterized by periods of reversible airflow obstruction known as asthma episodes or attacks.[4,5] Asthma attacks are caused by chronically hyperactive (contraction of the muscles surrounding the airways) and inflamed airways, leading to airflow obstruction.[5]. The CDC National Asthma Control Program aims to reduce the number of deaths, hospitalizations, emergency department visits, school or work days missed, limitations on activities due to asthma, and to increase the number of people receiving asthma management education and appropriate care. Asthma Facts – CDC’s National Asthma Control Program Grantees is a report produced by the CDC National Asthma Control Program (NACP) that describes asthma prevalence, healthcare utilization, asthma self-management education, and mortality for the program’s funded grantees in 34 states, the District of Columbia, and Puerto Rico. This report uses data from CDC surveys (Behavioral Risk Factor Surveillance System, Asthma Call-back Survey, and National Vital Statistics System). Adult and child current asthma prevalence estimates are presented by demographic characteristics and behavior risk factors. Asthma deaths from 1999–2010 are presented as number of deaths and rates in cases in which asthma was listed as the underlying cause of death by 35 NACP grantees (excludes Puerto Rico)
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