Responsive Asthma Care for Teens (ReACT): development protocol for an adaptive mobile health intervention for adolescents with asthma.
INTRODUCTION
Asthma is a leading cause of youth morbidity in the USA, affecting >8% of youth. Adherence to inhaled corticosteroids (ICS) can prevent asthma-related morbidity; however, the typical adolescent with asthma takes fewer than 50% of their prescribed doses. Adolescents are uniquely vulnerable to suboptimal asthma self-management due to still-developing executive functioning capabilities that may impede consistent self-regulation and weaken attempts to use problem solving to overcome barriers to ICS adherence.


METHODS AND ANALYSIS
The aims of this project are to improve adherence to ICS as an important step towards better self-management among adolescents aged 13-17 years diagnosed with asthma by merging the efficacious behaviour change strategies found in behavioural health interventions with scalable, adaptive mobile health (mHealth) technologies to create the Responsive Asthma Care for Teens programme (ReACT). ReACT intervention content will be developed through an iterative user-centred design process that includes conducting (1) one-on-one interviews with 20 teens with asthma; (2) crowdsourced feedback from a nationally representative panel of 100 adolescents with asthma and (3) an advisory board of youth with asthma, a paediatric pulmonologist and a behavioural health expert. In tandem, we will work with an existing technology vendor to programme ReACT algorithms to allow for tailored intervention delivery. We will conduct usability testing of an alpha version of ReACT with a sample of 20 target users to assess acceptability and usability of our mHealth intervention. Participants will complete a 4-week run-in period to monitor their adherence with all ReACT features turned off. Subsequently, participants will complete a 4-week intervention period with all ReACT features activated. The study started in October 2018 and is scheduled to conclude in late 2019.


ETHICS AND DISSEMINATION
Institutional review board approval was obtained at the University of Kansas and the University of Florida. We will submit study findings for presentation at national research conferences that are well attended by a mix of psychologists, allied health professionals and physicians. We will publish study findings in peer-reviewed journals read by members of the psychology, nursing and pulmonary communities.
['Cushing|Christopher C|CC|', 'Fedele|David A|DA|', 'Patton|Susana R|SR|', 'McQuaid|Elizabeth L|EL|', 'Smyth|Joshua M|JM|', 'Prabhakaran|Sreekala|S|', 'Gierer|Selina|S|', 'Koskela-Staples|Natalie|N|', 'Ortega|Adrian|A|', 'Fleming|Kandace K|KK|', 'Nezu|Arthur M|AM|']
D000280:Administration, Inhalation D000293:Adolescent D000305:Adrenal Cortex Hormones D001249:Asthma D006801:Humans D055118:Medication Adherence D008991:Monitoring, Physiologic D012107:Research Design D012648:Self Care D017216:Telemedicine
asthma mhealth ehealth