Enhancing Asthma Patients' Self-Management through Smartphone-Based Application: Design, Usability Evaluation, and Educational Intervention

Mehrdad Farzandipour, Ehsan Nabovati, Marzieh Heidarzadeh Arani, Hossein Akbari, Reihane Sharif, Shima Anvari, Mehrdad Farzandipour, Ehsan Nabovati, Marzieh Heidarzadeh Arani, Hossein Akbari, Reihane Sharif, Shima Anvari

Abstract

Objective: The aim of this study was to design and evaluate a smartphone-based application for improving self-management in patients with asthma and evaluate its effects on their knowledge.

Methods: In this applied research, based on the Clinical Practice Guideline and a systematic review, a questionnaire was designed to determine the application information content and functionality requirements by 15 pediatric and adult asthma and allergy specialist. Then the application was designed and developed using Adobe Air software on the Android operating system. Usability evaluation of the mobile application was performed using the standard questionnaire for user interaction satisfaction (QUIS), which completed by 30 patients with asthma, 8 information technology (IT) specialists, and 2 asthma and allergy specialists. Self-management knowledge of 30 asthma patients was measured using a researcher-made questionnaire before and after using the application.

Results: The number of specialists in the both Delphi rounds was 15 and the mean work experiences were 17.6 years. The most important elements for asthma self-management were avoiding exposure to allergen and triggers (96%), drug treatment (94.6%), and how to use the therapeutic tools (92.4%), and the most important functionalities were alerting the patients when they did not control asthma (92%), setting reminders for timely drug use (85.4%) and therapeutic tools (82.6%), recording prescription drugs (82.6%), and peak flow meter values (82%). Usability evaluation showed that 30 patients with asthma, 8 IT specialists, and 2 physicians evaluated the application at a "good" level. The mean score of the patients' knowledge before intervention was 2.43 ± 0.95 which after intervention was significantly increased to 4.3 ± 0.56 (p < 0.001).

Conclusion: Considering the desirable outcomes of application evaluation and a positive impact of this educational intervention on asthma patients' knowledge, it is possible to use mobile-based self-management programs to help these patients to manage illness and gain knowledge and self-management skills.

Conflict of interest statement

None declared.

Georg Thieme Verlag KG Stuttgart · New York.

Figures

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Research steps.

References

    1. Global Asthma Network.The global asthma report 2014Available at:. Accessed September 23, 2019
    1. Bousquet J, Bousquet P J, Godard P, Daures J P. The public health implications of asthma. Bull World Health Organ. 2005;83(07):548–554.
    1. Bateman E D, Hurd S S, Barnes P J et al.Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31(01):143–178.
    1. Nurmagambetov T, Kuwahara R, Garbe P. The economic burden of asthma in the United States, 2008–2013. Ann Am Thorac Soc. 2018;15(03):348–356.
    1. McDaniel M K, Waldfogel J. Racial and ethnic differences in the management of childhood asthma in the United States. J Asthma. 2012;49(08):785–791.
    1. Adler R N, McBride J. Tools and strategies for improving asthma management. Fam Pract Manag. 2010;17(01):16–21.
    1. Eakin M N, Rand C S. Improving patient adherence with asthma self-management practices: what works? Ann Allergy Asthma Immunol. 2012;109(02):90–92.
    1. British Thoracic Society Scottish Intercollegiate Guidelines Network.British Guideline on the Management of Asthma Thorax 20086304iv1–iv121.
    1. Hoskins G, McCowan C, Donnan P T, Friend J A, Osman L M; Asthma UK Scotland; Scottish Executive Health Department.Results of a national asthma campaign survey of primary care in Scotland Int J Qual Health Care 20051703209–215.
    1. Ring N, Malcolm C, Wyke S et al.Promoting the use of personal asthma action plans: a systematic review. Prim Care Respir J. 2007;16(05):271–283.
    1. Honkoop P J, Simpson A, Bonini M et al.MyAirCoach: the use of home-monitoring and mHealth systems to predict deterioration in asthma control and the occurrence of asthma exacerbations; study protocol of an observational study. BMJ Open. 2017;7(01):e013935.
    1. Morrison D, Wyke S, Agur K et al.Digital asthma self-management interventions: a systematic review. J Med Internet Res. 2014;16(02):e51.
    1. Marcano Belisario J S, Huckvale K, Greenfield G, Car J, Gunn L H. Smartphone and tablet self management apps for asthma. Cochrane Database Syst Rev. 2013;(11):CD010013.
    1. Burbank A J, Lewis S D, Hewes M et al.Mobile-based asthma action plans for adolescents. J Asthma. 2015;52(06):583–586.
    1. Cingi C, Yorgancioglu A, Cingi C C et al.The “physician on call patient engagement trial” (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients. Int Forum Allergy Rhinol. 2015;5(06):487–497.
    1. Cook K A, Modena B D, Simon R A. Improvement in asthma control using a minimally burdensome and proactive smartphone application. J Allergy Clin Immunol Pract. 2016;4(04):730–7370.
    1. Liu W-T, Huang C D, Wang C H, Lee K Y, Lin S M, Kuo H P. A mobile telephone-based interactive self-care system improves asthma control. Eur Respir J. 2011;37(02):310–317.
    1. Rhee H, Allen J, Mammen J, Swift M. Mobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study. Patient Prefer Adherence. 2014;8:63–72.
    1. Badawy S M, Barrera L, Sinno M G, Kaviany S, O'Dwyer L C, Kuhns L M. Text messaging and mobile phone apps as interventions to improve adherence in adolescents with chronic health conditions: a systematic review. JMIR Mhealth Uhealth. 2017;5(05):e66.
    1. Ryan D, Price D, Musgrave S D et al.Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial. BMJ. 2012;344:e1756.
    1. Licskai C, Sands T W, Ferrone M. Development and pilot testing of a mobile health solution for asthma self-management: asthma action plan smartphone application pilot study. Can Respir J. 2013;20(04):301–306.
    1. Zairina E, Abramson M J, McDonald C F et al.Telehealth to improve asthma control in pregnancy: a randomized controlled trial. Respirology. 2016;21(05):867–874.
    1. Huckvale K, Morrison C, Ouyang J, Ghaghda A, Car J. The evolution of mobile apps for asthma: an updated systematic assessment of content and tools. BMC Med. 2015;13(01):58.
    1. Househ M, Hossain N, Jamal A et al.A cross-sectional content analysis of Android applications for asthma. Health Informatics J. 2017;23(02):83–95.
    1. Huckvale K, Car M, Morrison C, Car J. Apps for asthma self-management: a systematic assessment of content and tools. BMC Med. 2012;10(01):144.
    1. Tinschert P, Jakob R, Barata F, Kramer J N, Kowatsch T. The potential of mobile apps for improving asthma self-management: a review of publicly available and well-adopted asthma apps. JMIR Mhealth Uhealth. 2017;5(08):e113.
    1. Lienhard K R, Legner C.Principles in the design of mobile medical apps: guidance for those who care. in 13th International Conference on Wirtschaftsinformatik (WI 2017), February 12–15, 2017St. Gallen, Switzerland. 1066–1080
    1. Farzandipour M, Nabovati E, Sharif R, Arani M H, Anvari S. Patient self-management of asthma using mobile health applications: a systematic review of the functionalities and effects. Appl Clin Inform. 2017;8(04):1068–1081.
    1. Berry D L, Blonquist T M, Nayak M M, Grenon N, Momani T G, McCleary N J. Self-care support for patients with gastrointestinal cancer: iCancerHealth. Appl Clin Inform. 2018;9(04):833–840.
    1. Badawy S M, Thompson A A, Kuhns L M. Medication adherence and technology-based interventions for adolescents with chronic health conditions: a few key considerations. JMIR Mhealth Uhealth. 2017;5(12):e202.
    1. Chin J P, Diehl V A, Norman K L.Development of an instrument measuring user satisfaction of the human-computer interfaceACM Digital Library.198810.1145/57167.57203
    1. Alexandru C-A.Usability testing and improvement of telemedicine websites, in School of Informatics2010, University of Edinburgh: Edinburgh:257. Available at:. Accessed November 13, 2019
    1. James D R, Lyttle M D. British guideline on the management of asthma: SIGN clinical guideline 141, 2014. Arch Dis Childhood Educ Pract. 2016;101:319–322.
    1. National Asthma Education and Prevention Program.Expert panel report 3 (EPR3): guidelines for the diagnosis and management of asthma J Allergy Clin Immunol 2007120(5, Suppl):S94–S138.
    1. Global Initiative for Asthma.Pocket guide for asthma management and prevention: a pocket guide for health professionalsAvailable at:. Accessed September 23, 2019
    1. Ministry of Health and Medical Education, Department of Noncommunicable Disease Management, National Committee of Chronic Respiratory Diseases: National Asthma Guideline: Prevention, Diagnosis and Management Protocol, vol. 1. Tehran, Iran: Mehre Touba Publications; 2016
    1. Haze K A, Lynaugh J.Building patient relationships: a smartphone application supporting communication between teenagers with asthma and the RN care coordinator Comput Inform Nurs 20133106266–271., quiz 272–273
    1. Rudin R S, Fanta C H, Predmore Z et al.Core components for a clinically integrated mHealth app for asthma symptom monitoring. Appl Clin Inform. 2017;8(04):1031–1043.
    1. Sapir T, Moreo K F, Greene L S et al.Assessing patient and provider perceptions of factors associated with patient engagement in asthma care. Ann Am Thorac Soc. 2017;14(05):659–666.
    1. Croft D R, Peterson M W. An evaluation of the quality and contents of asthma education on the World Wide Web. Chest. 2002;121(04):1301–1307.
    1. Nagappa A et al.Evaluation of web sites for quality and contents of asthma patient education. J Young Pharm. 2009;1(03):278.
    1. Park H-W, Min K U, Kim Y Y, Cho S H. Assessing the quality and contents of asthma-related information on the Korean internet as an educational material for patients. J Korean Med Sci. 2004;19(03):364–368.
    1. Basyouni M H et al.Online health information needs for patients with asthma in Saudi Arabia. J Consum Health Internet. 2015;19(01):13–24.
    1. Loerbroks A, Sheikh A, Leucht V, Apfelbacher C J, Icks A, Angerer P. Determinants of patients' needs in asthma treatment: a cross-sectional study. NPJ Prim Care Respir Med. 2016;26:16044.
    1. Lavorini F, Usmani O S. Correct inhalation technique is critical in achieving good asthma control. Prim Care Respir J. 2013;22(04):385–386.
    1. Peters D, Davis S, Calvo R A, Sawyer S M, Smith L, Foster J M. Young people's preferences for an asthma self-management app highlight psychological needs: a participatory study. J Med Internet Res. 2017;19(04):e113.
    1. Geryk L L, Roberts C A, Sage A J, Coyne-Beasley T, Sleath B L, Carpenter D M. Parent and clinician preferences for an asthma app to promote adolescent self-management: a formative study. JMIR Res Protoc. 2016;5(04):e229.
    1. Antoun J. Electronic mail communication between physicians and patients: a review of challenges and opportunities. Fam Pract. 2016;33(02):121–126.
    1. Patt M R, Houston T K, Jenckes M W, Sands D Z, Ford D E. Doctors who are using e-mail with their patients: a qualitative exploration. J Med Internet Res. 2003;5(02):e9.
    1. Ghazisaeedi M et al.Designing a mobile-based self-care application for patients with heart failure. J Health Biomed Informat. 2016;3(03):195–204.
    1. Langarizadeh M, Behzadian H, Samimi M. Development of personal health record application for gestational diabetes, based on smart phone. J Urmia Nurs Midwifery Fac. 2016;14(08):714–727.
    1. Ayatollahi H, Hasannezhad M, Fard H S, Haghighi M K. Type 1 diabetes self-management: developing a web-based telemedicine application. Health Inf Manag. 2016;45(01):16–26.
    1. Hamborg K C, Vehse B, Bludau H B. Questionnaire based usability evaluation of hospital information systems. Electronic J Inform Syst Eval. 2004;7(01):21–30.
    1. Joshi A, Wilhelm S, Aguirre T, Trout K, Amadi C. An interactive, bilingual touch screen program to promote breastfeeding among Hispanic rural women: usability study. JMIR Res Protoc. 2013;2(02):e47.
    1. Jan R-L, Wang J Y, Huang M C, Tseng S M, Su H J, Liu L F. An internet-based interactive telemonitoring system for improving childhood asthma outcomes in Taiwan. Telemed J E Health. 2007;13(03):257–268.
    1. Krishna S, Francisco B D, Balas E A, König P, Graff G R, Madsen R W; Randomized trial.Internet-enabled interactive multimedia asthma education program: a randomized trial Pediatrics 200311103503–510.
    1. Wyatt T H, Hauenstein E J. Pilot testing Okay With Asthma: an online asthma intervention for school-age children. J Sch Nurs. 2008;24(03):145–150.
    1. Mehdipour A et al.Evaluation of knowledge, attitudes and performance of the parents of preschool and primary school children referred to health centers of Qom city about the importance of preserving primary teeth and its related factors, Iran. Qom Univ Med Sci J. 2016;10(06):94–105.
    1. Qiu B, Huang L, Li Y.Health education for asthmatic patients and caregivers from nursing perspective 2017. Turku University of Applied Sciences; available at:
    1. Buijink A W, Visser B J, Marshall L. Medical apps for smartphones: lack of evidence undermines quality and safety. Evid Based Med. 2013;18(03):90–92.
    1. Badawy S M, Thompson A A, Liem R I. Technology access and smartphone app preferences for medication adherence in adolescents and young adults with sickle cell disease. Pediatr Blood Cancer. 2016;63(05):848–852.
    1. Badawy S M, Kuhns L M. Economic evaluation of text-messaging and smartphone-based interventions to improve medication adherence in adolescents with chronic health conditions: a systematic review. JMIR Mhealth Uhealth. 2016;4(04):e121.
    1. Iribarren S J, Cato K, Falzon L, Stone P W. What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions. PLoS One. 2017;12(02):e0170581.

Source: PubMed

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