Appl Clin Inform 2017; 08(04): 1068-1081
DOI: 10.4338/ACI-2017-07-R-0116
Review Article
Schattauer GmbH Stuttgart

Patient Self-Management of Asthma Using Mobile Health Applications: A Systematic Review of the Functionalities and Effects

Mehrdad Farzandipour
,
Ehsan Nabovati
,
Reihane Sharif
,
Marzieh Heidarzadeh Arani
,
Shima Anvari
Further Information

Publication History

08 July 2017

16 September 2017

Publication Date:
14 December 2017 (online)

Abstract

Objective The aim of this systematic review was to summarize the evidence regarding the effects of mobile health applications (mHealth apps) for self-management outcomes in patients with asthma and to assess the functionalities of effective interventions.

Methods We systematically searched Medline, Scopus, and the Cochrane Central Register of Controlled Trials. We included English-language studies that evaluated the effects of smartphone or tablet computer apps on self-management outcomes in asthmatic patients. The characteristics of these studies, effects of interventions, and features of mHealth apps were extracted.

Results A total of 10 studies met all the inclusion criteria. Outcomes that were assessed in the included studies were categorized into three groups (clinical, patient-reported, and economic). mHealth apps improved asthma control (five studies) and lung function (two studies) from the clinical outcomes. From the patient-reported outcomes, quality of life (three studies) was statistically significantly improved, while there was no significant impact on self-efficacy scores (two studies). Effects on economic outcomes were equivocal, so that the number of visits (in two studies) and admission and hospitalization-relevant outcomes (in one study) statistically significantly improved; and in four other studies, these outcomes did not improve significantly. mHealth apps features were categorized into seven categories (inform, instruct, record, display, guide, remind/alert, and communicate). Eight of the 10 mHealth apps included more than one functionality. Nearly all interventions had the functionality of recording user-entered data and half of them had the functionality of providing educational information and reminders to patients.

Conclusion Multifunctional mHealth apps have good potential in the control of asthma and in improving the quality of life in such patients compared with traditional interventions. Further studies are needed to identify the effectiveness of these interventions on outcomes related to medication adherence and costs.

Protection of Human and Animal Subjects

Human and/or animal subjects were not included in the study.


Funding

This study was supported by a grant from Kashan University of Medical Sciences Research Council (number: 9606).


 
  • References

  • 1 Global Asthma Network. The Global Asthma Report 2014. Auckland, New Zealand, 2014
  • 2 Masoli M, Fabian D, Holt S, Beasley R. ; Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004; 59 (05) 469-478
  • 3 World Health Organization. Chronic obstructive pulmonary disease (COPD). Geneva, Switzerland: WHO. Available at: http://www.who.int/respiratory/copd/en/ . Accessed September 2017
  • 4 Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National hospital discharge survey: 2007 summary. 2010: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics
  • 5 Accordini S, Corsico AG, Braggion M. , et al. The cost of persistent asthma in Europe: an international population-based study in adults. Int Arch Allergy Immunol 2013; 160 (01) 93-101
  • 6 Ehteshami-Afshar S, FitzGerald JM, Doyle-Waters MM, Sadatsafavi M. The global economic burden of asthma and chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2016; 20 (01) 11-23
  • 7 Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract 2017; 3: 1
  • 8 Iltchev P, Śliwczyński A, Szynkiewicz P, Marczak M. Mobile Health Applications Assisting Patients with Chronic Diseases: Examples from Asthma Care, in M-Health Innovations for Patient-Centered Care. IGI Global; 2016: 170-196
  • 9 Andrews KL, Jones SC, Mullan J. Asthma self management in adults: a review of current literature. Collegian 2014; 21 (01) 33-41
  • 10 Smith JR, Mugford M, Holland R. , et al. A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma. Health Technol Assess 2005; 9 (23) iii-iv , 1–167
  • 11 Welsh EJ, Hasan M, Li P. Home-based educational interventions for children with asthma. Cochrane Database Syst Rev 2011; (10) CD008469
  • 12 British Thoracic Society Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma: SIGN 153: Scottish Intercollegiate Guidelines Network; 2016. September 2016. Available at: https://www.brit-thoracic.org.uk/publication-library/bts-guidelines/
  • 13 National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol 2007; 120 (5, Suppl): S94-S138
  • 14 GINA. Global Strategy for Asthma Management and Prevention (2017 Update). Global Initiative for Asthma; 2017
  • 15 Razi SP, Piroozmand N, Zolfaghari M, Kazemnejad A, Firoozbakhsh S. Education of how-to-use peak flow meter and following up via SMS on asthma self-management. J Hayat 2013; 18 (04) 19-27
  • 16 López-Viña A, del Castillo-Arévalo E. Influence of peak expiratory flow monitoring on an asthma self-management education programme. Respir Med 2000; 94 (08) 760-766
  • 17 Morowatisharifabad M, Nadrian H, Falahi A, Mohammadi M. Predictors of self-management behaviors in patients with asthma based on Green's Model of Health Education Planning. J Sch Public Health Inst Public Health Res 2009; 7 (03) 37-49
  • 18 Ring N, Jepson R, Hoskins G. , et al. Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature. Patient Educ Couns 2011; 85 (02) e131-e143
  • 19 Roberts NJ, Younis I, Kidd L, Partridge MR. Barriers to the implementation of self management support in long term lung conditions. London J Prim Care (Abingdon) 2012; 5 (01) 35-47
  • 20 Kaya Z, Erkan F, Ozkan M. , et al. Self-management plans for asthma control and predictors of patient compliance. J Asthma 2009; 46 (03) 270-275
  • 21 Schnall R, Mosley JP, Iribarren SJ, Bakken S, Carballo-Diéguez A, Brown Iii W. Comparison of a user-centered design, self-management app to existing mHealth apps for persons living with HIV. JMIR Mhealth Uhealth 2015; 3 (03) e91
  • 22 Jahns R, Houck P. Mobile Health Market Report 2013–2017. 2013
  • 23 Marcano Belisario JS, Huckvale K, Greenfield G, Car J, Gunn LH. Smartphone and tablet self management apps for asthma. Cochrane Database Syst Rev 2013; 11 (11) CD010013
  • 24 Beratarrechea A, Lee AG, Willner JM, Jahangir E, Ciapponi A, Rubinstein A. The impact of mobile health interventions on chronic disease outcomes in developing countries: a systematic review. Telemed J E Health 2014; 20 (01) 75-82
  • 25 Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res 2012; 14 (03) e70
  • 26 El-Gayar O, Timsina P, Nawar N, Eid W. Mobile applications for diabetes self-management: status and potential. J Diabetes Sci Technol 2013; 7 (01) 247-262
  • 27 Hollenbach JP, Cushing A, Melvin E, McGowan B, Cloutier MM, Manice M. Understanding clinicians' attitudes toward a mobile health strategy to childhood asthma management: a qualitative study. J Asthma 2017; 54 (07) 754-760
  • 28 Cook KA, Modena BD, Simon RA. Improvement in asthma control using a minimally burdensome and proactive smartphone application. J Allergy Clin Immunol Pract 2016; 4 (04) 730-737.e1
  • 29 Ryan D, Price D, Musgrave SD. , et al. Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial. BMJ 2012; 344: e1756
  • 30 Zairina E, Abramson MJ, McDonald CF. , et al. Telehealth to improve asthma control in pregnancy: a randomized controlled trial. Respirology 2016; 21 (05) 867-874
  • 31 Cingi C, Yorgancioglu A, Cingi CC. , et al. The “physician on call patient engagement trial”(POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients. International Forum of Allergy and Rhinology—Wiley Online Library; 2015. Wiley Online Library
  • 32 Liu WT, Huang CD, Wang CH, Lee KY, Lin SM, Kuo HP. A mobile telephone-based interactive self-care system improves asthma control. Eur Respir J 2011; 37 (02) 310-317
  • 33 Morrison D, Wyke S, Agur K. , et al. Digital asthma self-management interventions: a systematic review. J Med Internet Res 2014; 16 (02) e51
  • 34 Hui CY, Walton R, McKinstry B, Jackson T, Parker R, Pinnock H. The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence. J Am Med Inform Assoc 2017; 24 (03) 619-632
  • 35 Ansari R, Ahmadian L, Bazargan Harandi N, Mirzai M. Determining the content of a pediatric asthma website from parents' perspective: the Internet use and information needs. Int J Pediatr 2017; 5 (06) 5113-5123
  • 36 Huang X, Matricardi PM. Allergy and asthma care in the mobile phone era. Clin Rev Allergy Immunol 2016; DOI: 10.1007/s12016-016-8542-y.
  • 37 Shegog R, Bartholomew LK, Parcel GS, Sockrider MM, Mâsse L, Abramson SL. Impact of a computer-assisted education program on factors related to asthma self-management behavior. J Am Med Inform Assoc 2001; 8 (01) 49-61
  • 38 Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163 (12) 1409-1416
  • 39 Garg AX, Adhikari NK, McDonald H. , et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005; 293 (10) 1223-1238
  • 40 Aitken M, Gauntlett C. Patient Apps for Improved Healthcare: From Novelty to Mainstream. Parsippany, NJ: IMS Institute for Healthcare Informatics; 2013
  • 41 Chaet AV, Morshedi B, Wells KJ, Barnes LE, Valdez R. Spanish-language consumer health information technology interventions: a systematic review. J Med Internet Res 2016; 18 (08) e214
  • 42 American Medical Association. Measures Development, Methodology, and Oversight Advisory Committee: Recommendations to PCPI Work Groups on Composite Measures. Chicago, IL: American Medical Association; 2010
  • 43 Nabovati E, Vakili-Arki H, Taherzadeh Z. , et al. Information technology-based interventions to improve drug-drug interaction outcomes: a systematic review on features and effects. J Med Syst 2017; 41 (01) 12
  • 44 Moher D, Liberati A, Tetzlaff J, Altman DG. , PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
  • 45 Thomas B, Ciliska D, Dobbins M, Micucci S. Quality Assessment Tool for Quantitative Studies Dictionary: The Effective Public Health Practice Project (EPHPP). McMaster University; 2008
  • 46 National Collaborating Centre for Methods and Tools. Quality Assessment Tool for Quantitative Studies. Ontario: McMaster University Hamilton; 2008
  • 47 Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract 2012; 18 (01) 12-18
  • 48 Effective Public Health Practice Project. Quality assessment tool for quantitative studies. 2010 ; Available at: http://www.ephpp.ca/tools.html
  • 49 Licskai C, Sands TW, Ferrone M. Development and pilot testing of a mobile health solution for asthma self-management: asthma action plan smartphone application pilot study. Can Respir J 2013; 20 (04) 301-306
  • 50 Burbank AJ, Lewis SD, Hewes M. , et al. Mobile-based asthma action plans for adolescents. J Asthma 2015; 52 (06) 583-586
  • 51 Dayer L, Heldenbrand S, Anderson P, Gubbins PO, Martin BC. Smartphone medication adherence apps: potential benefits to patients and providers. J Am Pharm Assoc (2003) 2013; 53 (02) 172-181
  • 52 Hayakawa M, Uchimura Y, Omae K, Waki K, Fujita H, Ohe K. A smartphone-based medication self-management system with realtime medication monitoring. Appl Clin Inform 2013; 4 (01) 37-52
  • 53 West DM. Improving health care through mobile medical devices and sensors. Brookings Institution Policy Report 2013; 10: 1-13
  • 54 Mosnaim GS, Powell LH, Rathkopf M. A review of published studies using interactive Internet tools or mobile devices to improve asthma knowledge or health outcomes. Pediatr Allergy Immunol Pulmonol 2012; 25 (02) 55-63
  • 55 Haze KA, Lynaugh J. Building patient relationships: a smartphone application supporting communication between teenagers with asthma and the RN care coordinator. Comput Inform Nurs 2013; 31 (06) 266-271 , quiz 272–273
  • 56 Carpenter DM, Geryk LL, Sage A, Arrindell C, Sleath BL. Exploring the theoretical pathways through which asthma app features can promote adolescent self-management. Transl Behav Med 2016; 6 (04) 509-518
  • 57 Roberts CA, Geryk LL, Sage AJ, Sleath BL, Tate DF, Carpenter DM. Adolescent, caregiver, and friend preferences for integrating social support and communication features into an asthma self-management app. J Asthma 2016; 53 (09) 948-954