A Randomized Controlled Trial of a Mobile Health Intervention to Promote Self-Management After Lung Transplantation

Abstract

Lung transplant recipients are encouraged to perform self-management behaviors, including (i) monitoring health indicators, (ii) adhering to their regimen, and (iii) reporting abnormal health indicators to the transplant coordinator, yet performance is suboptimal. When hospital discharge was imminent, this two-group trial randomized 201 recipients to use either the mobile health (mHealth) intervention (n = 99) or usual care (n = 102), to compare efficacy for promoting self-management behaviors (primary outcomes) and self-care agency, rehospitalization, and mortality (secondary outcomes) at home during the first year after transplantation. The mHealth intervention group performed self-monitoring (odds ratio [OR] 5.11, 95% confidence interval [CI] 2.95-8.87, p < 0.001), adhered to medical regimen (OR 1.64, 95% CI 1.01-2.66, p = 0.046), and reported abnormal health indicators (OR 8.9, 95% CI 3.60-21.99, p < 0.001) more frequently than the usual care group. However, the two groups did not differ in rehospitalization (OR 0.78, 95% CI 0.36-1.66, p = 0.51) or mortality (hazard ratio 1.71, 0.68-4.28, p = 0.25). The positive impact of the mHealth intervention on self-management behaviors suggests that the intervention holds promise and warrants further testing.

Trial registration: ClinicalTrials.gov NCT00818025.

Keywords: allied health/nursing; clinical research/practice; clinical trial; compliance/adherence; lung transplantation/pulmonology; outpatient care.

© Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1. Flow Diagram of Participant Recruitment and Retention

Data for survival status were available for 100% of subjects; data for clinical measures had intermittent missing as shown in Table 2.

Figure 2. Frequency of Critical Health Indicators Recorded versus Reported Per Treatment Group

Each circle represents an individual recipient. The Pocket PATH group reported most of their critical indicators—as illustrated by the proximity of the circles to the diagonal line, which represents the ideal situation (i.e., a participant appropriately reports all recorded critical health indicators).