Researchers at Rush University Medical Center in Chicago, IL and The University of Illinois at Chicago are using the Internet and motivational multimedia coupled with positive reinforcement via a smartphone application to try to improve asthma outcomes among low-income, minority adolescents with asthma.
Each participant in the study receives a smartphone preloaded with an application that uses a reward system to encourage them to proactively take their daily asthma controller medications. They also receive a free data plan (including unlimited talking, texting, email and internet) for the duration of their participation in the study. The study is funded by the National Institutes of Health (NIH).
"Adolescents love technology. They spend an enormous amount of time listening to music and playing videogames, as well as using computers and mobile phones. We believe that leveraging existing use of technology will be a great way to engage adolescents and motivate them to take their medication," said Dr. Giselle Mosnaim, an allergy and immunology specialist at Rush University Medical Center.
Some asthma patients need to use daily controller medications to prevent asthma symptoms and attacks. Without the medication, a serious breathing problem can result due to inflammation in the airways. This may lead to missed school days or visits to the emergency room.
"Adherence to daily asthma controller medications is key to asthma self-management, and preventing asthma symptoms and exacerbations," said Mosnaim. "Adolescents prefer instant gratification and often engage in risk-taking behavior. As a result, they are more inclined to bypass taking their daily medications (reward now) and take the risk that they may end up in the emergency room later," said Mosnaim.
"In our current study, we are providing them with immediate rewards for appropriate medication taking behavior. We are learning if they're more likely to take their medications by using positive reinforcement and incentives," Mosnaim continued.
The controller medication is fitted with a sensor that sends a signal to the smartphone application automatically when a dose is taken. The application and device were created by faculty and student collaborators in computer science, communications, psychology, and art and design at the University of Illinois at Chicago (UIC), with seed funding provided by the UIC Center for Clinical and Translational Science.
"The smartphone is equipped with a Bluetooth application that records every time the inhaler is used," Mosnaim said. "This connection gives us participants' times and dates, locations in latitude and longitude, as well as ambient air pollution and pollen levels from the National Allergy Bureau and Environmental Protection every time they take a puff."
"We want to know where they are when they use their medicines - to see if they took it because asthma symptoms were induced by exercise, such as being on a basketball court, or if poor air quality and/or high pollen counts could be an influencing factor."
Mosnaim monitors their real-time-medication-taking behavior via the data collected by the electronic dose counter, processed by the smartphone asthma application, and sent to the secure server. She and her colleagues may provide participants feedback by sending them messages via texting or email. Participants will also get immediate positive reinforcement when they take the dose within the correct time window.
Every time a participant takes the entire dose in the correct time window, they will score points in a virtual game (i.e., the participant scores a basket in a basketball game each time they take a dose), and they earn 50 cents that they can use at the Googleplay store to purchase music, apps, movies or television shows.
"There are so many opportunities for incorporating advanced computing technology in health-related applications. We will continue to see an explosion of this in the foreseeable future as individuals want to take greater control over their health. This is particularly evident in the rise of fitness and health-related applications for smartphones. Whereas there are many apps that claim to promote health, few are backed up by the expertise of real health organizations such as UIC's Medical campus and Rush University Medical Center," said Jason Leigh, UIC College of Engineering professor of computer science and director of the Electronic Visualization Laboratory.
Chicago has among the highest pediatric asthma rates of cities across the United States. According to the Centers for Disease Control and Prevention, child prevalence was higher in children aged 10-14 and 15-17 in Illinois compared with the 38 participating states' rates. There were 1.9 million asthma-related emergency department visits and 479,300 asthma-related hospitalizations in 2009. From 2001 through 2009, asthma rates rose the most among black children by nearly 50 percent. In 2007, asthma was linked to 3,447 deaths (approximately 9 per day).
Rush University Medical Center