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Background
Self-report is the most common method of measuring medication adherence but is influenced by recall error and response bias, and it typically does not provide insight into the causes of poor adherence. Ecological momentary assessment (EMA) of health behaviors using mobile phones offers a promising alternative to assessing adherence and c...
Contexts in source publication
Context 1
... automated adaptive phone survey included between 2-9 questions depending on responses to the questions and lasted between 15-90 seconds. Figure 1 shows the adaptive EMA items. Adolescents responded to numeric or yes/no items using the keypad on their mobile phone and qualitative questions by voice. ...
Context 2
... or 67% (SD 27.7) of all daily call responses each. There was some decline in calls with data over time (b=-0.29, P<.001). Missingness was defined as the number of days of no response to the calls. Missingness was not correlated with age, gender, household income, asthma control as measured by the ACT or controller adherence as measured by EMA (P=.86, .41, .10, .94, .12, respectively). However, missingness was significantly related to EMA-measured rescue inhaler adherence (r=-.33, P=.04), indicating that as the number of missed calls increased, adherence decreased. Table 1. Characteristics of the sample (n=53). ...
Citations
... A total ACT score of 25 indicates that asthma symptoms are fully controlled, while 20-24 indicates partially controlled and <20 indicates uncontrolled symptoms. 26 ...
... * The total ACT score can be 25 (fully controlled), 20-24 (partially controlled), or < 20 (uncontrolled).26 ...
Background:
Mobile phone apps have reached almost all sectors of everyday modern human life, including health promotion and patient education intervention. Regarding asthma self-management programs, apps are considered to be a potential learning medium for patients with asthma, especially young patients, due to their effectiveness in improving patients' knowledge and, consequently, the level of asthma control.
Objective:
The aim of this study was to evaluate the effectiveness of the AsmaDroid® mobile app, as compared with conventional educational methods, as a self-management educational intervention tool for improving asthma control among young patients.
Methods:
To determine the app's effectiveness, the study involved 140 participants from various backgrounds and applied a quasi-experimental method using a two-group pretest and posttest with a control group design. Specifically, the treatment groups received the AsmaDroid® app as a learning medium, while the control groups used conventional methods (e.g., books, posters, videos, and social media). Before and after a 4-week intervention period, all the participants of both groups were asked to complete the Asthma Control Test (ACT) questionnaire.
Results:
The results of this study revealed a significant difference of +1.4 (p < 0.0001) in the pretest and posttest scores of the ACT questionnaire from the intervention group, while no difference was found in the control group.
Conclusions:
Therefore, this study concluded that mobile app-assisted self-management educational intervention significantly improved the scores of the ACT questionnaire among young asthmatic patients.
... 15,[17][18][19] Additionally, mHealth has demonstrated its usefulness in several areas, including greater access to health information, remote patient monitoring and adherence measurement. [20][21][22][23][24] In patients with asthma, smart device ownership levels are similar to those of the general population, with one-third having used a health and fitness app and two-thirds showing interest in using apps to support their asthma management. 25 Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence, 24,26 namely the InspirerMundi app. ...
Background:
Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment.
Methods:
This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100).
Results:
A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001).
Conclusions:
Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.
... HCPs reported that the most significant benefit of medication monitoring is the ability to obtain real-time intervisit data and set alert thresholds based on the frequency of rescue inhaler use or the proportion of rescue versus controller inhaler use [170]. Others pointed out that it can be helpful to determine the context in which inhaler medication was used to assess the reasons for nonadherence [150,171,172]. ...
... Several ways of monitoring adherence were described, including electronic dose counters [3, 33,42,169,[173][174][175][176][177][178][179][180][181][182][183][184][185], electronic self-report of adherence [118,186], ecological momentary assessment [150,151,172], a chatbot that informs about medication adherence [187], and monitoring of inhaler adherence or technique through video or daily phone diary [49,151]. Electronic dose counters usually have the ability to register the amount of puffs used and sometimes to remind when the canister is empty [188] or when a dose is missed [189]. ...
... Increased usage of reliever medication was correlated with worse asthma control [3,172]. Walders et al [177] however stated that monitoring controller medication adherence may be more predictive of long-term morbidity than rescue medication use. ...
Background:
eHealth monitoring technologies offer opportunities to more objectively assess symptoms when they appear in daily life. Asthma is the most common chronic disease in childhood with an episodic course, requiring close follow-up of pediatric asthma control to identify disease deterioration, prevent exacerbations, and enhance quality of life. eHealth technologies in pediatric asthma care show promising results regarding feasibility, acceptability, and asthma-related health outcomes. However, broad systematic evaluations of eHealth technologies in pediatric asthma are lacking.
Objective:
The objective of this scoping review was to identify the types and applications of eHealth technologies for monitoring and treatment in pediatric asthma and explore which monitoring domains show the most relevance or potential for future research.
Methods:
A scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic and comprehensive search was performed on English papers that investigated the development, validation, or application of eHealth technologies for home monitoring or treatment of pediatric asthma in the following databases: PubMed, Cochrane Library, IEEE, Scopus, CINAHL, PsycINFO, and ACM Digital Library. Two authors independently assessed eligibility and extracted data. Data were presented by a descriptive analysis of characteristics and a narrative report for each eHealth domain.
Results:
The review included 370 manuscripts. The following 10 monitoring domains were identified: air quality, airway inflammation markers, lung function, physical activity, sleep, audiovisual, other physiological measurements, questionnaires, medication monitoring, and digital environment (ie, digital platforms, applications, websites, and software tools to monitor or support monitoring). Rising numbers of studies were seen, and the numbers accelerated in the last few years throughout most domains, especially medication monitoring and digital environment. Limited studies (35/370, 9.5%) of multiparameter monitoring strategies, using three or more domains, were found. The number of monitoring validation studies remained stable, while development and intervention studies increased. Intervention outcomes seemed to indicate the noninferiority and potential superiority of eHealth monitoring in pediatric asthma.
Conclusions:
This systematic scoping review provides a unique overview of eHealth pediatric asthma monitoring studies, and it revealed that eHealth research takes place throughout different monitoring domains using different approaches. The outcomes of the review showed the potency for efficacy of most monitoring domains (especially the domains of medication monitoring, lung function, and digital environment). Future studies could focus on modifying potentially relevant hospital-based diagnostics for the home setting to investigate potential beneficial effects and focus on combining home-monitoring domains to facilitate multiparameter decision-making and personalized clinical decision support.
... A review on the use of the apps for improving asthma self-management skills in teenager asthmatics confirmed that the apps could be considered effective health intervention [20]. Another study found that the apps provided a feasible method to assess asthma symptoms and adherence in adolescents [21]. In Indonesia, where this study took place, the prevalence of asthma was 2.4% with the recurrence proportion of 57.5% [22]. ...
... Emotions of embarrassment are recognized to influence adherence (28). More than half of non-adherent episodes were amongst friends in one study (48) and hesitation in participating in social activities has also been noted (28). Moreover, social media influences are a very relevant entity for the current adolescent cohort and the influence should be explored in clinical consultations. ...
Asthma remains the most prevalent chronic respiratory disease of childhood. Severe asthma accounts for a minority group of patients but with substantial morbidity burden. It may reflect disease which is resistant to treatment or that which is difficult to treat, or a combination of both. The adolescent patient cohort denote a unique group and are the focus of this review. This group of patients embody transitioning priorities and evolving health beliefs, all of which may influence the management and burden of disease. Factors of importance include the influence of physiological parameters such as sex and race, which have confer implications for medical management and non-physiological factors, such as adherence, risk-taking behavior, and vaping. The holistic approach to management of severe asthma within this group of patients must acknowledge the evolving patient independence and desire for autonomy and strive for a collaborative, patient tailored approach. This review will focus on the factors that may pose a challenge to the management of severe adolescent asthma whilst offering suggestions for changes in practice that might harness patient priorities and shared clinical decision-making.
... These are easily available and accessible. [11,12,13,14] 3. Personalised action plans and use of daily medications is recommended to prevent asthma. [15]. ...
An experimental factorial research design was used to compare an effectiveness of WhatsApp based self-care information and manual mode of information among asthmatic patients on quality of life. 10 adult asthma patients between 18-55 years of age were selected randomly in the study at the outpatient department of respiratory medicine. Patients were divided in WhatsApp based self-care information group and manual mode of self -care information group. The operational information in the form of “Asthma self-care information manual” was distributed by the researcher to manual mode of self-care information group in the preferred language of patient after collecting pre-test data from patients. For WhatsApp based self-care information group, the operational information was communicated through WhatsApp messenger app in 15 days to asthma patients after collecting pre-test score of patients. Post-test score of Quality of life of these patients was assessed again after 6 months of intervention. The mean of pre-test score for manual mode of self-care information patients is 117.5 and WhatsApp mode of information patient is 119.7. Mean of Post–test score is 167 and 168.8 respectively. This shows that post-test score is improved for both the group patients. The calculated t values was 1.148 which is less than the tabulated value hence the research hypothesis is accepted which states that WhatsApp based self-care information effective than the Manual mode of self-care information among asthmatic patients on quality of life
... The current pilot study used electronic adherence monitoring and EMA to: 1) determine variability in adherence to inhaled corticosteroids over time; and 2) explore individual differences in the relationships between psychosocial variables and inhaled corticosteroid adherence at the day-level, above and beyond asthma symptoms. We selected asthma symptoms as a covariate since youth frequently endorse higher levels of inhaled corticosteroid adherence when experiencing symptoms (Horne, 2006;McQuaid et al., 2003;Mulvaney et al., 2013). Regarding aim one, we hypothesized that adherence to inhaled corticosteroids would fluctuate over time (i.e., on some days individuals would be fully adherent, on other days partially adherent, and on others nonadherent). ...
... This suggests that when an individual adolescent experiences more symptoms than they are accustomed to experiencing on a given day they may be more likely to take their inhaled corticosteroid medication. This finding is consistent with previous research highlighting misunderstandings regarding the role of inhaled corticosteroids as a daily preventative medication (Horne, 2006;McQuaid et al., 2003;Mulvaney et al., 2013). At the between-person level, we found that lower adherence to inhaled corticosteroids was associated with more asthma symptoms. ...
Adolescents with asthma endorse psychosocial difficulties as barriers to inhaled corticosteroid adherence. This study examined patterns of variability in adherence and within-person associations of psychosocial variables with adherence across days. Participants included twenty-five adolescents (Mage = 14.7, SD = 1.68; 48% male) with persistent asthma. We measured adherence via electronic monitoring. Adolescents completed daily surveys measuring asthma symptoms, stress, mood, and affect. We examined within-person differences in the effect of symptoms and psychosocial variables on adherence. Adherence decreased over time. The addition of a random slope improved model fit (− 2ΔLL(1) = 9.36, p < .01). Greater asthma symptoms were significantly associated with higher adherence at the within-person level and with lower adherence between persons. We observed evidence of individual differences in the associations of stress and affect with adherence. Within-person, day-level fluctuations in adherence occur. Symptoms and psychosocial variables may influence adherence. Individually tailored interventions may effectively address nonadherence.
... 14 En un estudio en adolescentes aproximadamente la mitad de los casos de incumplimiento ocurrió en presencia de amigos. 15 El olvido también se ha relacionado con la falta de adherencia en los adolescentes. 16,17 Psicosocialmente, el adolescente debe equilibrar su deseo para la autonomía, la comunicación y el conflicto familiar, las relaciones con los compañeros y las demandas académicas y vocacionales dentro del contexto del manejo de la enfermedad. ...
La aceptación de padecer una enfermedad crónica y aprender a convivir con ésta puede ser un proceso lento para el paciente y su familia. Los niños y los adolescentes con una enfermedad crónica se enfrentan a un desafío que requiere afrontar la responsabilidad y exigencias de la necesidad de un tratamiento diario a largo plazo que muchas veces requiere adaptar sus actividades y su vida para cumplir con el mismo. El objetivo del tratamiento en las enfermedades crónicas es minimizar los síntomas, alcanzar el control o modificar la evolución natural para lograr una calidad de vida adecuada. Adherencia significa la aceptación de un rol activo en el propio cuidado de la salud, pero que debe comprender la colaboración entre el paciente, su familia y el equipo de salud. Esta colaboración debe incluir confianza, términos como negociación, toma de decisiones en forma conjunta y comunicación para determinar el tratamiento adecuado de la enfermedad. La adherencia al tratamiento es un problema y constituye un reto y una preocupación para los médicos que tratan a pacientes con enfermedades crónicas porque la falta de adherencia genera empeoramiento de la enfermedad, aumento del número de hospitalizaciones, altos costos para el paciente, la familia y el sistema de salud.
... Interactive mobile phone based applications are successfully used to assess daily symptoms, adherence to medications in adolescent asthma patients. These are easily available and accessible [12,13,14,15,16]. ...
Background: Asthma is a chronic inflammatory reaction that causes hypersensitivity in airways resulting in constant mucus production. As a result of this the typical symptoms associated with Asthma can be seen. WhatsApp is a popular app available in almost all android phones; this app is popular for sending and receiving messages along with additional features of sending images videos and links. Information can be shared at a time to a large number of people by creating groups in this app. The use of WhatsApp messaging for self-care information among asthma patients has yet to be researched. So research question which is framed is, “Is WhatsApp based self-care information effective than manual mode of self-care information on quality of life of asthma patients?”. The study aim is to compare an effectiveness of WhatsApp based self-care information and manual mode of information among asthmatic patients on quality of life. Methodology: Study Design: Experimental factorial research design Population: Adult asthma patients between 18-55 years of age Sample Size: 200. Material: Standard Quality of Life scale for Asthma patient. Expected Results: WhatsApp mode of self-care information may be more effective than the manual mode of self-care information. Quality of life of asthma patients will be improved. Conclusion: Conclusion will be drawn after statistical analysis of the collected data.
... Similar to the EMMS, patient self-report technologies vary in their specific functionalities, yet they all gather subjective medication adherence data by interacting with the patient via phone call [16,18,19,38,52,56,[81][82][83][84], smart button [58], eDiary [85], online platform [86,87] or mobile app [88]. Patient adherence is available in real-time for most patient-self report devices [ ...
Background
Accurate measurement and monitoring of patient medication adherence is a global challenge because of the absence of gold standard methods for adherence measurement. Recent attention has been directed toward the adoption of technologies for medication adherence monitoring, as they provide the opportunity for continuous tracking of individual medication adherence behavior. However, current medication adherence monitoring technologies vary according to their technical features and data capture methods, leading to differences in their respective advantages and limitations. Overall, appropriate criteria to guide the assessment of medication adherence monitoring technologies for optimal adoption and use are lacking.
Objective
This study aims to provide a narrative review of current medication adherence monitoring technologies and propose a set of technology assessment criteria to support technology development and adoption.
Methods
A literature search was conducted on PubMed, Scopus, CINAHL, and ProQuest Technology Collection (2010-present) using the combination of keywords medication adherence, measurement technology, and monitoring technology. The selection focused on studies related to medication adherence monitoring technology and its development and use. The technological features, data capture methods, and potential advantages and limitations of the identified technology applications were extracted. Methods for using data for adherence monitoring were also identified. Common recurring elements were synthesized as potential technology assessment criteria.
Results
Of the 3865 articles retrieved, 98 (2.54%) were included in the final review, which reported a variety of technology applications for monitoring medication adherence, including electronic pill bottles or boxes, ingestible sensors, electronic medication management systems, blister pack technology, patient self-report technology, video-based technology, and motion sensor technology. Technical features varied by technology type, with common expectations for using these technologies to accurately monitor medication adherence and increase adoption in patients’ daily lives owing to their unobtrusiveness and convenience of use. Most technologies were able to provide real-time monitoring of medication-taking behaviors but relied on proxy measures of medication adherence. Successful implementation of these technologies in clinical settings has rarely been reported. In all, 28 technology assessment criteria were identified and organized into the following five categories: development information, technology features, adherence to data collection and management, feasibility and implementation, and acceptability and usability.
Conclusions
This narrative review summarizes the technical features, data capture methods, and various advantages and limitations of medication adherence monitoring technology reported in the literature and the proposed criteria for assessing medication adherence monitoring technologies. This collection of assessment criteria can be a useful tool to guide the development and selection of relevant technologies, facilitating the optimal adoption and effective use of technology to improve medication adherence outcomes. Future studies are needed to further validate the medication adherence monitoring technology assessment criteria and construct an appropriate technology assessment framework.
