IMAAP: Development and evaluation of an Interactive Mobile Asthma Action Plan

Cincinnati Childrens Hosp Med Ctr, Cincinnati OH

Investigators

Abstract

Project Summary This project will include the development and evaluation of IMAAP, an Interactive Mobile Asthma Action Plan to support asthma self-management and adherence to ‘as needed’ rescue medications, which are a critical component of preventing exacerbations. The burden of asthma continues to fall disproportionately on historically marginalized populations (i.e., individuals experiencing social determinant of health [SDOH]-related challenges such as racism and discrimination, difficulties accessing healthcare, financial instability, and limited social support). An innovative tool that presents a patients’ physician-prescribed Asthma Action Plan recommendations in a way that all youth can understand is needed to improve access to care and the quality of asthma care, decrease disparities, and promote health equity. IMAAP will be an innovative, easy-to-use technology that leverages objective assessment of lung function (mobile spirometry), quantitative symptom report, and an individualized AAP to provide personalized, real-time treatment recommendation decision support to empower adolescents to improve their health. With this project, IMAAP will first be iteratively developed through discovery interviews and feedback from adolescents from marginalized populations, their caregivers, and health care providers. Discovery interviews with health care providers, specifically, will be used to develop an innovative algorithm that will map asthma symptom and lung function presentations to patients’ individualized Asthma Action Plans. Prototype testing will be completed to ensure the safety of patients using IMAAP and to expeditiously obtain user feedback from patients and caregivers in a variety of situations prior to going live. Finally, a Phase IIb pilot randomized controlled trial will be conducted to compare a sample of 20 adolescents with moderate to severe persistent asthma (ages 12-18) using IMAAP to 20 adolescents in a treatment as usual group. All adolescents in the development and RCT phases will have ≥1 SDOH-related challenge. The primary outcome for this trial will be feasibility of IMAAP. Feasibility will be assessed by comparing rates of participation, engagement, enrollment, retention, and reach to a priori criteria. User acceptability and usability will also be assessed as secondary outcomes, as well as electronic monitored rescue medication adherence and health outcomes. As an exploratory aim, we will examine social determinants of health as predictors of feasibility and health outcomes. Results will lead to further refinements and an adapted version of IMAAP ready for full-scale efficacy testing in a future trial.