Dose Matters: A Smartphone Application to Improve Asthma Control Among Patients at an Urban Pediatric Primary Care Clinic

Abstract

<b><i>Objective:</i></b> As the most common chronic condition of childhood, asthma is a frequent target for family education. However, current educational strategies rarely tailor to learning style or literacy level. Thus, we developed and implemented a smartphone application (app) leveraging gamified features entitled <i>CHANGE Asthma</i> ("Clinic, Home, And on the Go Education for Asthma"). We subsequently assessed its impact on asthma control. <b><i>Methods:</i></b> Patients aged 4-11 years with a previously documented childhood asthma control test (C-ACT) score of <20, indicating poor control, were recruited to participate in this randomized control pilot study. The intervention group downloaded <i>CHANGE Asthma</i>; asthma control was assessed at enrollment and at follow-up. The changes in C-ACT score in both groups were compared using analysis of covariance (primary outcome). App usage was monitored for 4 months following download, and the relationship between usage time, and the change in C-ACT score was assessed via linear regression. <b><i>Results:</i></b> The control and intervention groups both included 20 caregivers with 75% of participants completing follow-up. Although C-ACT scores among intervention participants significantly improved at follow-up, compared to their own baseline (<i>P</i> = 0.04), the change of C-ACT score did not significantly differ from that of the control group (<i>P</i> = 0.78). Among the intervention participants, there was a positive, dose-dependent relationship between app usage time and positive change in C-ACT score (<i>P</i> = 0.03). <b><i>Conclusion:</i></b> Usage of a gamified app was associated with a dose-dependent improvement in asthma control over time, suggesting that further evaluation of apps for asthma education, and perhaps for other chronic conditions, is warranted.