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.
Highlights
Asthma is a chronic inflammatory disease of the airways that is characterized physiologically by excessive variation in airflow and manifests symptomatically as repeated episodes of coughing, wheezing, shortness of breath, and chest tightness [1]
Mixed effects models assessed whether the features of the Mobile technology interventions (MTI) and how often a person engaged with MTI moderated the effects of MTI
MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes
Summary
Background Asthma is a chronic inflammatory disease of the airways that is characterized physiologically by excessive variation in airflow and manifests symptomatically as repeated episodes of coughing, wheezing, shortness of breath, and chest tightness [1]. Despite current guidelines recommending action plans and daily preventer medication, patients’ actual adherence to either treatment remains low. A longitudinal study following middle-aged adults with asthma over 12 months found that 73.8% (259/351) used inadequate preventer medication [8]. This is concerning, as research suggests that appropriate use of preventer medication could protect against progressive decline in lung function, which is associated with increasing asthma severity [8]. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. 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
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