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. 2023 Jun;30(2):415-424.
doi: 10.1007/s10880-022-09905-5. Epub 2022 Aug 20.

Technology-Assisted Stepped-Care to Promote Adherence in Adolescents with Asthma: A Pilot Study

Rachelle R Ramsey  1   2 , Jill M Plevinsky  3   4 , Theresa W Guilbert  5   6 , Julia K Carmody  7   8 , Kevin A Hommel  9   5
Affiliations

Technology-Assisted Stepped-Care to Promote Adherence in Adolescents with Asthma: A Pilot Study

Rachelle R Ramsey et al. J Clin Psychol Med Settings. 2023 Jun.

Abstract

To examine the feasibility, acceptability, and preliminary efficacy of a technology-assisted stepped-care behavioral intervention to improve adherence in adolescents with asthma. Thirty adolescents (Mage = 14.66, 53% male) with moderate to severe-persistent asthma completed daily adherence monitoring and medication reminders via a mobile app (Step 1). Participants with < 68% adherence during Step 1 received a telehealth behavioral intervention (Step 2). Twenty-six of 30 participants (87%) completed Step 1. Step 2 was indicated for 18 participants and was completed by 17. Participants favorably rated their experience in the study. Improvements in adherence (40-58%, p = .048) and decreases in asthma composite severity scores (CASI 6.08-5.08, p = .023) were observed for the full sample. Technology-assisted stepped-care is feasible and acceptable. Participants demonstrated improved adherence and asthma composite severity scores once they received the appropriate step of the intervention. Future studies should include a control group, a longer time-frame and an intermediate intervention step.

Keywords: Adherence; Adolescents; Asthma; Behavioral intervention; Stepped-care.

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Conflict of interest statement

Dr. Guilbert reports personal fees from American Board of Pediatrics; Pediatric Pulmonary Subboard, personal fees from GSK, personal fees from TEVA, personal fees from Novartis, grants from NIH, grants and personal fees from Sanofi/Regeneron, grants and personal fees from Astra-Zeneca, royalties from UpToDate. All other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
This figure depicts the average ratings provided by participants upon completion of the study when asked about their experience participating in the study. Participants were asked to respond to the questions listed on a scale of 0–4 with 0 indicating “Not at all” and four indicating “Extremely”. The last question was only answered by participants who received Step 2
Fig. 2
Fig. 2
This figure depicts participants’ progression through the study with the arrow at the top of the figure displaying the timeline of the study design. 30 participants were enrolled, 26 of whom completed the baseline period of adherence monitoring and received Step 1. Eight participants demonstrated an average adherence higher than 68% and remained in Step 1 for the duration of the study. Of the 18 participants whose average adherence fell below 68% during Step 1, 17 received Step 2, and 1 was lost to follow-up
See this image and copyright information in PMC

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