Engaging Adolescent Asthmatics in Symptom Control and Self-Management Using an Online Peer Social Network: A Randomized Controlled Trial
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Abstract
Background: Asthma is the most common chronic condition affecting American children under the age of 18, with more than 10 million (14%) having been diagnosed. Compared to adults, children are at a greater risk of having an asthma attack and asthma-related hospital visit, and account for an estimated $56 billion in healthcare costs annually. Healthy People 2020 objectives highlight the need to improve patient education to recognize early signs and symptoms, and have physicians assess asthma control more frequently. The Asthma Control Test (ACT) has been demonstrated to be a reliable and valid means of detecting changes in asthma control over time, but its utility has been limited to date by its mode of administration during scheduled office visits by paper format. Improving the accessibility of the ACT, administering it more regularly, and using automated scoring to provide instant feedback on current status and trends may be useful in gauging success of therapeutic interventions and identifying deteriorations of asthma control. We know that 95% of adolescents are online; 81% use some type of social media, and 67% report that they use social media at least once a day. Therefore, social media offers a novel approach for improving adolescents’ adherence to monitoring by making the ACT readily accessible. Among adolescents who use social media, 94% report having a Facebook account, making it a prime channel for reaching this target population. Using Facebook to create a social network of adolescent peers with asthma may reinforce treatment adherence and result in better asthma control.
Objective: Our primary objective was to determine the effect of the Facebook intervention on adolescents’ management of asthma symptoms as measured by trends in ACT scores. Our secondary objectives were to compare the frequency of hospital emergency room (ED) and inpatient admissions between intervention and control groups, assess patient and provider engagement and correlate patient engagement with ED visits, and evaluate patients’ level of knowledge about asthma, in addition to the overall acceptability of the Facebook intervention.
Methods: 120 adolescents between 14-17 years old who fulfilled the inclusion criteria of having a current prescription for a controller medication for asthma and an active Facebook account were randomized to either the intervention group using Facebook or to a control group receiving usual care, and followed up for 12 months. Patients in the intervention group were invited onto a “secret†study Facebook group, and were prompted to take the ACT each month. In the case that a patients’ score was found to be critical (14 or below), an automatic notification would advise them on their condition and appropriate next steps. A notification would also at this time be sent to their referring physician and delegated parent or guardian via email informing them of this change in ACT trend, allowing for timely follow-up. Additionally, we hoped that bringing teens together on Facebook would foster a sense of community and social support to reduce stigma associated with asthma and empower teens in self-managing their condition.
Results & Conclusions: Research in Progress
Objective: Our primary objective was to determine the effect of the Facebook intervention on adolescents’ management of asthma symptoms as measured by trends in ACT scores. Our secondary objectives were to compare the frequency of hospital emergency room (ED) and inpatient admissions between intervention and control groups, assess patient and provider engagement and correlate patient engagement with ED visits, and evaluate patients’ level of knowledge about asthma, in addition to the overall acceptability of the Facebook intervention.
Methods: 120 adolescents between 14-17 years old who fulfilled the inclusion criteria of having a current prescription for a controller medication for asthma and an active Facebook account were randomized to either the intervention group using Facebook or to a control group receiving usual care, and followed up for 12 months. Patients in the intervention group were invited onto a “secret†study Facebook group, and were prompted to take the ACT each month. In the case that a patients’ score was found to be critical (14 or below), an automatic notification would advise them on their condition and appropriate next steps. A notification would also at this time be sent to their referring physician and delegated parent or guardian via email informing them of this change in ACT trend, allowing for timely follow-up. Additionally, we hoped that bringing teens together on Facebook would foster a sense of community and social support to reduce stigma associated with asthma and empower teens in self-managing their condition.
Results & Conclusions: Research in Progress
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