Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones

Vol 15, No 7 (2013) > Mulvaney

Original Paper

Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones

Shelagh A Mulvaney^1,2,3, PhD; Yun-Xian Ho², PhD; Cather M Cala⁴; Qingxia Chen^2,5, PhD; Hui Nian⁵, MS; Barron L Patterson³, MD; Kevin B Johnson^2,3, MD, MS

¹School of Nursing, Vanderbilt University School of Medicine, Nashville, TN, United States
²Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States
³Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
⁴School of Medicine, University of Alabama, Birmingham, AL, United States
⁵Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States

Corresponding Author:

Shelagh A Mulvaney, PhD

School of Nursing
Vanderbilt University School of Medicine
461 21st Ave
Nashville, TN, 37240
United States
Phone: 1 615 322 1198
Fax: 1 615 343 5898
Email: shelagh.mulvaney [at] vanderbilt.edu

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ABSTRACT

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.

(J Med Internet Res 2013;15(7):e141)
doi:10.2196/jmir.2413

KEYWORDS

asthma; adherence; mobile technology; adolescent; assessment

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