Engaging adolescent asthmatics in symptom control and self-management using an online peer social network: findings from a randomized controlled trial

Shiyi Zan szan@partners.org


Background: Asthma is the most common chronic condition affecting those under the age of 18, and account for an estimated $56 billion in healthcare costs annually. The Asthma Control Test (ACT) is a reliable and valid means of detecting changes in asthma control over time, but its utility has been limited to date, mostly due to 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. 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. Intervention subjects were invited onto a ‘secret’ (private) 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), they would receive an automatic notification advising them on their condition and appropriate next steps. A similar notification would be sent to their referring physician and a delegated parent/guardian via email informing them of the change in ACT trend, permitting timely follow-up.

Results & Conclusions: (Research in Progress)
108 patients (mean age 15 yrs) completed the study in February 2015. We observed a significant improvement in ACT score for subjects in both intervention and control groups from pre- to post-study (average of 1.33 points, p=0.001). The percentage of subjects with ACT scores <=14 decreased by 50% in the control group (12.8% to 5.4%, p=0.001) but there was no significant change detected in the percentage of participants with poor asthma control (as measured by ACT) in the intervention group. We are currently in the process of compiling and analyzing data for our secondary outcomes.

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