JMIR Publications

ABSTRACT

Background:

Uncontrolled asthma poses substantial negative personal and health system impacts. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes.

Objective:

To design, develop, and assess the utilization of an asthma collaborative self-management platform (breathe) using content based on international evidence-based clinical guidelines.

Methods:

Well-established user-centered design methods, combined with ISO-certified development processes were used to design and develop breathe. The data collection protocol collected user data for 12 months, with clinic visits at baseline, six, and 12 months. Utilization outcomes included user interactions with the platform, user impressions, self-reported medication use and asthma symptom profile, reported peak flow measurement, the delivery and response to e-mail reminders.

Results:

We designed and developed breathe as a web-based mHealth platform accessible on smartphones, tablets, or desktop. The system enabled collaborative self-management and self-monitoring of asthma patients through: (1) assessment of asthma control, (2) real-time access to a dynamic asthma action plan, (3) access to real-time environmental conditions, and (4) risk-reduction messaging. We enrolled 123 participants with a mean age of 45.2 years (Standard deviation (SD) ±15.8). A majority were female (72.5%), had a smartphone (66.7%), and had a mean Asthma Control Test score of 18.3 ± 4.9. Participants indicated a strong belief that the program had improved their ability to manage asthma and the tool scored 71.1 ± 18.9 on the System Usability Scale. The platform sent 7.96 reminder e-mails per patient per week (pppw), patients accessed breathe 3.08 times pppw, journaled symptoms 2.56 times pppw, reported medication usage 0.30 times pppw, and reported peak flow measurements 0.92 times pppw. breathe calculated patients’ action plan zone of control 2.72 times pppw, with patients being in the green (well-controlled) zone in 48% of the total calculations. Usage analysis showed that 60% of the participants used the app at week 4 and only 30% by week 45.

Conclusions:

breathe was designed and developed to enable patients to collaboratively self-manage their asthma. Strong usage is seen at the intervention’s initiation, followed by a reduction potentially due to the high proportion of well-controlled individuals with asthma, infrequent clinician surveillance, lack of a strong engagement technique, and patients achieving the right “digital dose” of the intervention. Usage patterns observed during this intervention provide important learnings for future mHealth developments regarding reminder design and sustained effects, ideal times for interaction with patient, surveillance effect, and engagement methods matched to patient health characteristics.