JMIR Publications

ABSTRACT

Background:

Inhaled medication is the preferred route of administration for COPD. The compliance rate of inhaled medication in COPD patients is less than 50%, which increases the risk of acute exacerbations. Considering the complex steps of inhaled medication, improving inhaled medication compliance not only considers the consistency between medication frequency and medical advice but also evaluates whether the patient has mastered the inhaler technique to achieve the correct dose.

Objective:

This study aimed to explore the effectiveness of an inhaled medication education program ("Inhaling-Health" website) based on Fogg's Behavior Model and gamification design on inhaled medication compliance and other health-related outcomes in COPD patients.

Methods:

In a non-randomized, two arms and concurrent parallel design, we assigned 102 COPD patients from respiratory medicine clinics of two hospitals in Zhejiang Province, China between April and May 2023 and divided into the control group (n=51) and experimental group (n=51). All participants completed the intervention, with 94 completing six months of follow-up. Two independent samples t-test and Mann-Whitney U test were used to analyze group differences and generalized estimating equations were used to analyze repeated measurements.

Results:

After the intervention, all outcome measures improved compared to baseline. In the generalized estimation equation, the "Inhaling-Health" website gradually improved the TAI total scores starting from 2 months post-intervention compared to the control group. It had a separate positive effect on inhaler technique. In addition, the website was more effective in reducing the mMRC score than the routine way of inhaled medication education starting from 3 months post-intervention. The website was also more effective than the conventional intervention in improving HRQoL and COPD-Q scores compared to the control group.

Conclusions:

The gamified inhaled medication education program based on Fogg's Behavior Model can improve inhaled medication adherence, inhaler technique accuracy and health literacy of COPD patients, help reduce the severity of dyspnea and COPD physical symptoms, improve lung function and HRQoL of COPD patients, and reduce the risk of acute exacerbations. This study can provide a reference for inhaled medication education in COPD patients. Clinical Trial: This study was registered with the China Clinical Trials Registry (ChiCTR2300070213) , and recruiting participants began in April 2023.