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Mobile Technology Aids Treatment Protocol Adherence
By David Yeager

These days, the way to a teen’s heart is through his or her mobile device. That’s one of the reasons Michael Seid, PhD, a professor of pediatrics and the director of Health Outcomes and Quality of Care Research in the division of pulmonary medicine at Cincinnati Children’s Hospital Medical Center (CCHMC), decided to use cell phone reminders to measure the effectiveness of asthma self-management interventions in teens. In a pilot study of 26 adolescents with moderate to severe asthma, Seid and his colleagues sent text messages to encourage compliance with treatment protocols. CCHMC partnered with GenerationOne to develop the technology.

The clinical trial lasted 14 months. One of the pilot’s goals was to determine whether adolescents with moderate to severe asthma would respond well to an intervention based on problem solving and motivational factors. Other goals were to beta test a mobile phone-based platform for the intervention, prove its feasibility, and determine its short-term efficacy.

“We wanted to see if the intervention could be delivered as we wanted it to be delivered and whether or not there was the possibility of an effect before we did a larger study,” says Seid, the study’s principal investigator.

The teens, aged 12 to 16, were divided into an intervention group of 12 patients and a control group of 14 patients. There were more females than males. All participants were given a choice between cell phones or access to more minutes. All the participants elected to make use of the additional minutes.

The participants received education about treatment compliance. In addition, the intervention group received motivational interviewing and problem-solving training, each of which were delivered in two counseling sessions. The intervention group also received text message reminders related to treatment adherence.

The text messages fell into three categories. One was a reminder message. Each participant chose his or her message. Some were related to taking medications on schedule, and others were reminders for participants to keep their inhalers with them.

The second type of message was a motivational booster related to the teens’ goals. For example, Seid says some of them wanted to get their asthma under control so they could play football.

The third type of message was a check-in where the participant was asked whether he or she was doing all right and given the phone number for a problem-solving coach if they needed further assistance. Seid says an important aspect of all three types of messages is that they were customized by the teens themselves.

As with any study, there were some challenges that had to be overcome. The first was to recruit enough participants. Seid says it’s generally difficult to convince people to come to the hospital for any reason, let alone a clinical trial.

There were also some technical issues that needed to be addressed. Early on, the researchers planned to use a Web application protocol push in which the phones find the messages on the Internet. This method was unpopular with participants.

“The kids actually hated that because, for them, it took forever to load the message. They’re used to texting, so we had to reengineer the way the reminders came to be more like what they’re used to,” says Seid. “Texting, for them, is how it works. They don’t open an envelope that says, ‘Loading, loading, loading…’ It takes less than three seconds, but for them that’s almost unacceptable.”

Once these challenges were addressed, the study went smoothly, and Seid says the teens responded well to the intervention. Detailed results are not yet available, but Seid is pleased with the preliminary data. He and his colleagues are planning to submit the results for publication.

“The treatment itself was about compliance, if you will, about adherence. And there were only two sessions. And all of them came to both,” says Seid. “We had a 100% follow-up rate in terms of the assessment afterward.”

Seid and his colleagues are in the process of finding funding for a large-scale trial. He hopes to enroll approximately 300 patients. The structure of the study will remain the same.

“Basically what we’re going to do is try the very same thing with more kids at more sites just [to see] if the results hold in a bigger sample,” he says.

— David Yeager is a freelance writer and editor based in Royersford, Pa.