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Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones

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...

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Autores principales: Mulvaney, Shelagh A, Ho, Yun-Xian, Cala, Cather M, Chen, Qingxia, Nian, Hui, Patterson, Barron L, Johnson, Kevin B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications Inc. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785951/
https://www.ncbi.nlm.nih.gov/pubmed/23864345
http://dx.doi.org/10.2196/jmir.2413
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author Mulvaney, Shelagh A
Ho, Yun-Xian
Cala, Cather M
Chen, Qingxia
Nian, Hui
Patterson, Barron L
Johnson, Kevin B
author_facet Mulvaney, Shelagh A
Ho, Yun-Xian
Cala, Cather M
Chen, Qingxia
Nian, Hui
Patterson, Barron L
Johnson, Kevin B
author_sort Mulvaney, Shelagh A
collection PubMed
description 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 collecting related data that can be clinically useful for adherence problem solving. OBJECTIVE: To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making. METHODS: We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline. RESULTS: The sample consisted of 53 adolescents who were primarily African American (34/53, 64%) and female (31/53, 58%) with incomes US$40K/year or lower (29/53, 55%). The majority of adolescents (37/53, 70%) reported that they carried their phones with them everywhere, but only 47% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67%). Response frequency declined during the last week of the month (b=-0.29, P<.001) and was related to EMA-reported levels of rescue inhaler adherence (r= 0.33, P=.035). Using EMA, adolescents reported an average of 0.63 (SD 1.2) asthma symptoms per day and used a rescue inhaler an average of 70% of the time (SD 35%) when they experienced symptoms. About half (26/49, 53%) of the instances of nonadherence took place in the presence of friends. The EMA-measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT (r=-0.33, P=.034). CONCLUSIONS: Mobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web-based support system.
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spelling pubmed-37859512013-10-17 Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones Mulvaney, Shelagh A Ho, Yun-Xian Cala, Cather M Chen, Qingxia Nian, Hui Patterson, Barron L Johnson, Kevin B J Med Internet Res Original Paper 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 collecting related data that can be clinically useful for adherence problem solving. OBJECTIVE: To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making. METHODS: We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline. RESULTS: The sample consisted of 53 adolescents who were primarily African American (34/53, 64%) and female (31/53, 58%) with incomes US$40K/year or lower (29/53, 55%). The majority of adolescents (37/53, 70%) reported that they carried their phones with them everywhere, but only 47% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67%). Response frequency declined during the last week of the month (b=-0.29, P<.001) and was related to EMA-reported levels of rescue inhaler adherence (r= 0.33, P=.035). Using EMA, adolescents reported an average of 0.63 (SD 1.2) asthma symptoms per day and used a rescue inhaler an average of 70% of the time (SD 35%) when they experienced symptoms. About half (26/49, 53%) of the instances of nonadherence took place in the presence of friends. The EMA-measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT (r=-0.33, P=.034). CONCLUSIONS: Mobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web-based support system. JMIR Publications Inc. 2013-07-17 /pmc/articles/PMC3785951/ /pubmed/23864345 http://dx.doi.org/10.2196/jmir.2413 Text en ©Shelagh A Mulvaney, Yun-Xian Ho, Cather M Cala, Qingxia Chen, Hui Nian, Barron L Patterson, Kevin B Johnson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.07.2013. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Mulvaney, Shelagh A
Ho, Yun-Xian
Cala, Cather M
Chen, Qingxia
Nian, Hui
Patterson, Barron L
Johnson, Kevin B
Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones
title Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones
title_full Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones
title_fullStr Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones
title_full_unstemmed Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones
title_short Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones
title_sort assessing adolescent asthma symptoms and adherence using mobile phones
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785951/
https://www.ncbi.nlm.nih.gov/pubmed/23864345
http://dx.doi.org/10.2196/jmir.2413
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