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

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Abstract

ABSTRACT
Objectives Telehealth is promoted as a strategy to support self-management of long-term conditions. The aim of this systematic review is to identify which information and communication technology (ICT) features implemented in mobile ‘apps’ to support asthma self-management are associated with adoption, adherence to usage, and clinical effectiveness.
Methods We systematically searched nine databases, scanned reference lists, and undertook manual searches (January 2000 to April 2016). We include randomised controlled trials (RCTs) and quasi-experimental studies with adults. All eligible papers were assessed for quality, and we extracted data on the features included, health-related outcomes (asthma control; exacerbation rate), process/intermediate outcomes (adherence with monitoring or treatment, self-efficacy), level of adoption of and adherence to use of technology. Meta-analysis and narrative synthesis were used.
Results We included 12 RCTs employing a range of technologies. A meta-analysis (n=3) showed improved asthma control (mean difference -0.25 (95%CI -0.37 to -0.12). Included studies incorporated 10 features grouped into seven categories (education, monitoring/electronic diary, action plans, medication reminders/prompts, facilitating professional support, raising patient awareness of asthma control, and decision support for professional). The most successful interventions included multiple features, but effects on health related outcomes were inconsistent. No studies explicitly reported the adoption of and adherence to the technology system.
Conclusion Meta-analysis of data from three trials showed improved asthma control, though overall the clinical effectiveness of apps, typically incorporating multiple features, varied. Further studies are needed to identify the features that are associated with adoption of and adherence to use of the mobile app and those that improve health outcomes.
Original languageEnglish
JournalJournal of the American Medical Informatics Association
Early online date2 Oct 2016
DOIs
Publication statusE-pub ahead of print - 2 Oct 2016

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