Adam Sage

Adolescent, caregiver, and friend preferences for integrating social support and communication features into an asthma self-management app.

Abstract Objectives: This study examines: 1) adolescent preferences for using asthma self-management mobile applications (apps) to interact with their friends, caregivers, medical providers, and other adolescents with asthma and 2) how caregivers and friends would use mobile apps to communicate with the adolescent and serve as sources of support for asthma management. Methods: We recruited 20 adolescents aged 12–16 years with persistent asthma, their caregivers (n = 20), and friends (n = 3) from two suburban pediatric practices in North Carolina. We gave participants iPods with two preloaded asthma apps and asked them to use the apps for 1 week. Adolescents and caregivers provided app feedback during a semi-structured interview at a regularly-scheduled clinic appointment and during a telephone interview one week later. Friends completed one telephone interview. Interviews were audio-recorded and transcribed verbatim. An inductive, theory-driven analysis was used to identify themes and preferences. Results: Adolescents preferred to use apps for instrumental support from caregivers, informational support from friends, and belonging and informational support from others with asthma. The majority of adolescents believed apps could enhance communication with their caregivers and medical providers, and the theme of self-reliance emerged in which caregivers and adolescents believed apps could enable adolescents to better self-manage their asthma. Friends preferred to use apps to provide instrumental and informational support. Conclusions: Given preferences expressed in this study, apps may help adolescents obtain social support to better self-manage their asthma. Future app-based interventions should include features enabling adolescents with asthma to communicate and interact with their caregivers, medical providers, and friends.

A Review of Electronic Devices to Assess Inhaler Technique

Purpose of ReviewMultiple electronic devices exist that provide feedback on the accuracy of patient inhaler technique. Our purpose is to describe the inhaler technique feedback provided by these devices, including specific technique steps measured, how feedback is displayed, target of feedback (patient, provider, researcher), and compatibility with inhaler type (metered-dose inhaler [MDI], diskus, etc.).Recent FindingsWe identified eight devices that provide feedback on inhaler technique. Only one device assessed all evidence-based MDI technique steps. Most devices provide limited real-time feedback to patients, if any feedback at all.SummaryTechnologies to assess inhaler technique are advancing and hold great potential for improving patient inhaler technique. Many devices are limited in their ability to detect all evidence-based technique steps and provide real-time user-friendly feedback to patients and providers. Usability tests with patients and providers could identify ways to improve these devices to improve their utility in clinical settings.

Communicating information concerning potential medication harms and benefits: What gist do numbers convey?

OBJECTIVES Fuzzy trace theory was used to examine the effect of information concerning medication benefits and side-effects on willingness to use a hypothetical medication. METHODS Participants (N=999) were recruited via Amazon Mechanical Turk. Using 3×5 experimental research design, each participant viewed information about medication side effects in 1 of 3 formats and information about medication benefits in 1 of 5 formats. For both side-effects and benefits, one format presented only non-numeric information and the remaining formats presented numeric information. RESULTS Individuals in the non-numeric side-effect condition were less likely to take the medication than those in the numeric conditions (p<0.0001). In contrast, individuals in the non-numeric benefit condition were more likely to take the medication than those in the numeric conditions (p<0.0001). CONCLUSIONS Our findings suggest that non-numeric side-effect information conveys the gist that the medication can cause harm, decreasing willingness to use the medication; whereas non-numeric benefit information has the opposite effect. PRACTICE IMPLICATIONS Presenting side-effect and benefit information in non-numeric format appears to bias decision-making in opposite directions. Providing numeric information for both benefits and side-effects may enhance decision-making. However, providing numeric benefit information may decrease adherence, creating ethical dilemmas for providers.

Exploring youth and caregiver preferences for asthma education video content

Abstract Objective: This study examines (1) whether youth and their caregivers have different preferences for asthma education video topics and (2) if education topic preferences vary by youth and caregiver sociodemographic characteristics. Methods: Youth (n = 83) ages 7–17 years with persistent asthma and their caregivers were recruited at two pediatric practices in North Carolina. Sociodemographic information and youth and caregiver preferences for nine asthma video education topics were collected during in-person interviews. Bonferroni-corrected Chi-square or McNemar tests (α = 0.0056) were used to compare youth and caregivers differences in topic preferences and topic preferences by youth and caregiver sociodemographic characteristics, including gender, race, ethnicity, and age. Results: Youth were primarily male (52%) and from low-income families (74%; caregiver annual income less than

Adolescent Preferences and Design Recommendations for an Asthma Self-Management App: Mixed-Methods Study

30 000) and many were Hispanic (45%). Youth and parents expressed the most interest in the following two topics: “how to deal with triggers” (90% and 95%, respectively) and “how to keep asthma under control” (87% and 96%, respectively). Caregivers and children were discordant for two topics: “the difference between a rescue and controller medicine” and “how to [help your child] talk to your [his/her] friends about asthma.” No differences were found between youth and caregiver sociodemographic characteristics and video topic preferences. Conclusions: Youth with persistent asthma and their caregivers differed in their asthma education topic preferences, but preferences did not vary by caregiver or youth sociodemographic characteristics. Studies examining the effectiveness of interventions tailored to differences in educational preferences of youth with asthma and their caregivers are needed.

Online Information-Seeking Behaviors of Parents of Children With ADHD

Background Approximately 10% of adolescents in the United States have asthma. Adolescents widely use apps on mobile phones and tablet technology for social networking and gaming purposes. Given the increase in recreational app use among adolescents, leveraging apps to support adolescent asthma disease management seems warranted. However, little empirical research has influenced asthma app development; adolescent users are seldom involved in the app design process. Objective The aim of this mixed-methods study was to assess adolescent preferences and design recommendations for an asthma self-management app. Methods A total of 20 adolescents with persistent asthma (aged 12-16 years) provided feedback on two asthma self-management apps during in-person semistructured interviews following their regularly scheduled asthma clinic visit and via telephone 1 week later. Interviews were audiorecorded, transcribed verbatim, analyzed using SPSS v24, and coded thematically using MAXQDA 11. Results Regarding esthetics, app layout and perceived visual simplicity were important to facilitate initial app use. Adolescents were more likely to continually engage with apps that were deemed useful and met their informational needs. Adolescents also desired app features that fit within their existing paradigm or schema and included familiar components (eg, medication alerts that appear and sound like FaceTime notifications and games modeled after Quiz Up and Minecraft), as well as the ability to customize app components. They also suggested that apps include other features, such as an air quality tracker and voice command. Conclusions Adolescents desire specific app characteristics including customization and tailoring to meet their asthma informational needs. Involving adolescents in early stages of app development is likely to result in an asthma app that meets their self-management needs and design preferences and ultimately the adoption and maintenance of positive asthma self-management behaviors.

Youth Views on Communication About ADHD and Medication Adherence

This article describes (a) parent questions about ADHD (attention deficit/hyperactivity disorder), (b) parent Internet use to seek ADHD information, and (c) associations between type of Internet access and ADHD information-seeking. Seventy parents of children (ages 7-17 years) with ADHD completed questionnaires after their child’s visit with their pediatrician. Bivariate relationships were assessed using chi-square statistics, Pearson correlation coefficients, or t tests. Parents identified an average of 8.9 questions about ADHD for their child’s provider. Common questions were related to medication and long-term implications of ADHD. A majority of parents searched the Internet for general ADHD information (87%) and ADHD medication information (81%). White parents accessed the Internet significantly more via home computer, mobile phone, and tablet, and significantly less via public library than non-White parents. Parents who accessed the Internet via home computers and tablets were more likely to search the Internet for ADHD medication information than parents who did not.

Assessing the Quality and Suitability of Multimedia Resources to Assist Patients With Patient Portal Use.

The purpose of this study was to examine youth perceptions of attention deficit hyperactivity disorder (ADHD) communication with their pediatric providers, their reported adherence to their ADHD medications, and their desired location for an ADHD educational program. Youth ages 7 through 17 with an ADHD diagnosis were recruited. A research associate interviewed the youth. Parents completed demographic questionnaires. Seventy families participated. One-third of the youth wanted more discussion about ADHD with their providers during visits. The average youth had over eight questions about ADHD and its treatment. Most youth wanted to learn about ADHD at their provider’s office. Non-white and older youth were significantly more likely to be less adherent to their ADHD medications. Youth want their providers to engage them more during visits. Providers should take advantage of this interest to engage youth more in discussions regarding ADHD and its treatment during pediatric ADHD visits.

Exploring the theoretical pathways through which asthma app features can promote adolescent self-management

The adoption of electronic health records (EHRs) has increased dramatically within recent years, with estimates indicating that 59% of hospitals now have an EHR system. This growth in health information technology has the potential to positively influence health care quality, efficiency, and satisfaction. Increased adoption of EHRs has led to greater availability of patient portals, interactive personal health records that are linked to the EHR. The portal provides patients with a variety of features, including the ability to access their medical record, contact their provider, schedule clinic visits, and view test results. There is mounting evidence that use of patient portals is linked to improved patient satisfaction, health care service delivery, and health outcomes including improved glycemic control, blood pressure control, and health screenings. Despite these benefits, patient portal use remains low. In a 2014 study evaluating patient portal engagement at 8 primary care practices, only 26% of patients created a patient portal account. Patients logged into their accounts an average of 4 times (range of 1-261 times) during the 31-month study; 27% of patients logged in only one time after account creation. Although reasons for low uptake of patient portals are likely multifactorial, poor patient understanding of how to access and effectively use the tool could be a substantial contributor. Patients may not receive guidance from clinic staff on how to access and use patient portals, and written instructions on portal websites are often difficult for many patients to understand and follow. Use of multimedia resources could be an effective strategy to help overcome barriers regarding portal functionality and navigation, particularly among patients with limited health literacy skills. We identified and characterized online multimedia patient portal resources that are provided by US hospitals to educate patients on how to use their patient portal. The quality and suitability of these resources were critically assessed using a standardized assessment tool. Process to Identify Multimedia Resources