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Coker TR, Mitchell SJ, Lowry SJ, Klein EJ, Stout JW, Brown JC, Liljenquist KS, Wingfield E, Horn IB. Text2Breathe: Text-Message Intervention for Parent Communication and Pediatric Asthma. Acad Pediatr 2023; 23:123-129. [PMID: 35577281 PMCID: PMC10650351 DOI: 10.1016/j.acap.2022.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/04/2022] [Accepted: 05/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Mobile health technology offers promise for reducing disparities in pediatric asthma care and outcomes by helping parents more effectively communicate with their children's primary care providers and manage their children's asthma. This study tested the impact of a text messaging program on emergency department utilization and asthma morbidity. METHODS A randomized controlled trial enrolled 221 parents of Medicaid-insured children visiting the emergency departments of 2 urban children's hospitals in the Pacific Northwest for an asthma-related concern between September 2015 and February 2019. Standardized surveys were administered to parents at baseline and 12 months later to assess the primary outcomes of emergency department utilization and morbidity as well as primary care utilization, parent communication self-efficacy, and asthma self-management knowledge. The intervention group received brief in-person education on partnering with primary care providers, followed by 3 months of educational text messages. RESULTS Participants were mostly female, English speakers, of minority race and ethnicity, and living below 200% of the federal poverty level. Negative binomial and linear regressions indicated no significant group differences in annual number of emergency department visits, morbidity, parent communication self-efficacy, or asthma self-management knowledge at 12 months' follow-up, adjusting for baseline covariates. Average annual rate of primary care visits for asthma was 35% higher in the intervention group compared to control group at follow-up (95% confidence interval 1.03-1.76, P = .03). CONCLUSIONS This parent-focused text message intervention did not impact emergency department utilization or asthma morbidity; however, results suggest its potential for enhancing use of primary care for management of pediatric chronic conditions.
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Affiliation(s)
- Tumaini R Coker
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Stephanie J Mitchell
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash.
| | - Sarah J Lowry
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Eileen J Klein
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine (EJ Klein and J Brown), Seattle, Wash
| | - James W Stout
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Department of Health Services, University of Washington (JW Stout and KS Liljenquist), Seattle, Wash
| | - Julie C Brown
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine (EJ Klein and J Brown), Seattle, Wash
| | - Kendra S Liljenquist
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Department of Health Services, University of Washington (JW Stout and KS Liljenquist), Seattle, Wash
| | - Elizabeth Wingfield
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Ivor B Horn
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
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Murphy J, Molloy GJ, Hynes L, McSharry J. Young adult preferences for digital health interventions to support adherence to inhaled corticosteroids in asthma: a qualitative study. Health Psychol Behav Med 2022; 10:557-578. [PMID: 35756333 PMCID: PMC9225781 DOI: 10.1080/21642850.2022.2085709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Adherence to inhaled corticosteroids (ICS) among young adults living with asthma is low and in need of appropriate intervention. Digital health interventions (DHIs) have demonstrated potential to improve ICS adherence; however, young adult preferences for these DHIs and how their use could support adherence in this population remain understudied. Therefore, this study aimed to explore young adult preferences for ICS adherence supports and potential DHI features to deliver these supports, in order to improve adherence behaviour throughout this critical developmental stage of the lifespan. Methods: Qualitative, semi-structured interviews were conducted with 13 young adults living with asthma. Analysis followed an inductive, reflexive thematic approach. Results: Participant’s age ranged from 18 to 30 years (M = 24.7; 8 female). Three themes were developed from the analysis: ‘Enabling young adults to find their ‘own way of knowing', ‘Support for making a habit of adherence’, and ‘Providing accessible information’ which included the sub-themes: ‘Education on asthma self-management and medication’, ‘Self-monitoring information’ and ‘Personal feedback on outcomes of adherence’. Suggested features to deliver these supports included a medication and prescription refill reminder, adherence charts, symptom and trigger monitoring, rewards for adherence, visual representations of lungs demonstrating the impact of adherence and lung function monitoring. Conclusion: DHIs may offer an appropriate solution to improve suboptimal adherence to ICS in young adults. However, it is crucial that young adult preferences for adherence supports and features are integrated into these interventions in order to optimise engagement and support adherence behaviour in this population.
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Affiliation(s)
- Jane Murphy
- Medication Adherence Across the Lifespan Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Gerard J Molloy
- Medication Adherence Across the Lifespan Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Lisa Hynes
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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Mosnaim G, Safioti G, Brown R, DePietro M, Szefler SJ, Lang DM, Portnoy JM, Bukstein DA, Bacharier LB, Merchant RK. Digital Health Technology in Asthma: A Comprehensive Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2377-2398. [PMID: 33652136 DOI: 10.1016/j.jaip.2021.02.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.
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Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, North Shore University Health System, Evanston, Ill
| | | | - Randall Brown
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa
| | - Michael DePietro
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Don A Bukstein
- Allergy, Asthma and Sinus Center, Milwaukee, Greenfield, Wis
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Rajan K Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, Calif
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Premkumar A, Lovecchio FC, Stepan JG, Kahlenberg CA, Blevins JL, Albert TJ, Cross MB. A Novel Mobile Phone Text Messaging Platform Improves Collection of Patient-Reported Post-operative Pain and Opioid Use Following Orthopedic Surgery. HSS J 2019; 15:37-41. [PMID: 30863231 PMCID: PMC6384206 DOI: 10.1007/s11420-018-9635-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prospective collection of patient-reported opioid consumption and pain levels post-surgically may hold value in highlighting solutions related to the opioid crisis. Traditional methods for collecting patient-reported outcomes after surgery, such as paper surveys, often have poor response rates, and electronic messaging may offer more convenience and therefore yield more robust data. QUESTIONS/PURPOSES The purpose of this study was to evaluate whether a novel mobile phone short message service (SMS) platform would lead to better patient response rates to surveys on pain and opioid use than data-collection tools. METHODS An SMS text messaging platform was created and implemented between September 2017 and May 2018 at an orthopedic specialty hospital. The purpose was to collect reports on opioid consumption and pain levels twice a day for 6 weeks post-surgery from patients who had undergone total hip or knee arthroplasty or a single-level lumbar microdiscectomy or decompression spine surgery. Patients who responded to fewer than 50% of the text messages were excluded. RESULTS Our mobile phone text messaging platform was used by 183 patients, demonstrating a significantly higher response rate (96.1%) than our institution's post-operative email registry capture, as well as the majority of published response rates for post-operative outcomes captured through electronic and traditional data-collection systems. Response rate remained consistently high among the various surgeons and across patients, regardless of age. CONCLUSIONS This application of a widely available technology can improve the measurement of post-operative patient-reported outcomes. Such data can in turn be used in the development of strategies to reduce post-operative opioid use. The adoption of novel technologies at a patient level will play a key role in combating the opioid epidemic.
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Affiliation(s)
- Ajay Premkumar
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Francis C. Lovecchio
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jeffrey G. Stepan
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Cynthia A. Kahlenberg
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jason L. Blevins
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Todd J. Albert
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Michael B. Cross
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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