Evaluating Mobile Apps for Asthma Management

This assignment requires students to analyze various studies and research papers on the use of mobile apps for asthma management. The student needs to critically evaluate the content and tools provided by these apps, as well as their impact on patient engagement and self-management. The assignment also involves a review of existing literature on this topic, including articles from reputable sources such as BMJ and Journal of Medical Internet Research.

Tailoring and personalization of
application in health intervention for
asthma management

TABLE OF CONTENTS
Abstract............................................................................................................................................1
Keyword..........................................................................................................................................1
Methods...........................................................................................................................................1
Literature search..........................................................................................................................1
Inclusion- Exclusion Criteria.......................................................................................................2
INTRODUCTION...........................................................................................................................2
ANALYSIS......................................................................................................................................3
RESULTS........................................................................................................................................5
DISCUSSION..................................................................................................................................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

Abstract
Asthma is stated to be a high burden disease and is specified to be a long term condition in
the patient suffering from recurrent attacks of wheeziness. This needs an effective treatment for
its opportune management to prevent any of its atrocious consequences at the end. It is with a
special context of Australian people who are known to suffer the most from asthma. Asthma is
also known to be a preventable disease and whose appropriate management can save the life of
people who are unknowingly suffering from it. The current report is focussed on a similar
consideration of managing asthma through various effective strategies of managing it in a
planned way. It is with a prime consideration of managing it in a personalised manner where the
medication will be provided in accordance to the specific need identified in an individual. A
tailored procedure of managing this illness is due to the fact of asthma’s severity and frequency
from one individual to another that differs to a great extent. It is also with a special consent of
provisioning such individualised treatment through certain technical means like a mobile
application which is specially designed for managing asthma in Australian adults.
Keyword
Asthma management, personalized medication, self-management of chronic disease, eHealth,
interactive health communication, asthma control, public health intervention, tailoring of mobile
application
Methods
Literature search
A search was carried to find relevant set of articles for carrying out this study. It depicted
the use of database search done through several online databases. Herein, the articles were
mainly taken from PubMed and Google Scholar. A recent search was undertaken on March 2018
where the selected articles were published between 2006 to 2018. A keyword research was also
carried out to target more refined set of articles, done with the help of 2 main Boolean operators.
Following search string was taken into consideration using AND- OR: (“asthma management
OR asthma control OR self-management of chronic disease”) AND (“personalized medication
OR tailored mobile application”) AND (“public health intervention OR interactive health
communication”) AND (“eHealth OR mHealth”).
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Inclusion- Exclusion Criteria
This criterion is applied to set boundaries while conducting a systematic review and
searching relevant articles for the same. This reflects as an initiation point to start investigating
the framed research question and is being created on the basis of various undertaken factors, as
specified below-
Basis of Selection Inclusion Exclusion
Date of publication Articles published after 2005
has been referred.
Articles published before 2005
has not been taken into
consideration.
Type of publication Originally carried studies have
been taken into consideration.
Any study in the form of
review or editorial have not
been referred.
Exposure of interest Self-management public
health intervention via internet
or mobile for asthmatic
patients have been included.
Self-management practices as
public health intervention via
mobile or internet for person
suffering from any other type
of illness which is not
associated with lungs has been
excluded.
Geographic location of the
study
Studies undertaken in context
of Australian and American
regions have been considered.
Studies conducted outside
Australia and America have
been excluded.
Language Articles written in English
have been taken into
consideration.
Articles in other languages are
not referred.
INTRODUCTION
This is on considering a rising use of mobile technology in the globe at a greater pace where
nearly 80% of the total population are known to possess a mobile phone. Out of which, more
than 20% have smartphones. This has led to a faster development of mobile apps with a prime
focus on promoting a healthy lifestyle to the individuals via mHealth. This has depicted a vital
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involvement of World health organisation (WHO) and Global Observatory for eHealth (GOe) in
the growing market of eHealth (Corderoy, A., 2014). This is basically to encourage public health
and medicinal practices supported by several mobile devices. It usually involves mobile phones,
personal digital assistants (PDAs), other wireless and monitoring devices for the patients. The
app developers have addressed fiscal benefits from the development of such health related
programs as an ultimate solution for the management of chronic diseases, like asthma. It has also
been estimated that, by the end of 2018, more than 3 billion users of tablets and smartphones are
predicted to download mHealth.
These tools are then apparent to empower the patients by enabling them to easily share the
information with the care providers and educate themselves by together connecting with others.
This particular app called mHealth has been specified to be one of the most potential technology
in accordance to UK Health Department. They have thus suggested it to be prescribed as a vital
part of care for managing long term conditions like asthma in patients. Considering this, the
hospital systems of New York is also permitting the physicians to advise such health oriented
apps to the patients (Pluddemann, 2018). The present report has also focussed on a similar aspect
of provisioning tailored and personalised medication to the patients suffering from asthma. This
is basically to focus upon the specific requirements of the asthmatic patients whose frequency
and severity largely differs from one other. Below is the review of various articles undertaken to
study a similar topic of asthma management through mobile application as a personalised or
tailored technology for public health intervention.
ANALYSIS
This section has reviewed some chosen articles that has been selected on the basis of above
specified criteria of inclusion- exclusion. On whose basis, the foremost article by Barata,
Kowatsch and Tinschert (2016) has studied the existence of a personal MobileCoach. It is
however with a specific concern of tailoring the behavioural interventions as per the identified
needs of the individual participants. Herein, the MobileCoach app has been specified to be an
authoring tool for the healthcare professionals as an open basis platform of behavioural
intervention. It is with a specific concern of designing evidence based, low priced and scalable
digital health interventions, also termed as DHI.
This is especially for the treatment of non-communicable diseases like asthma by capably
meeting the requirement of scared resources in the healthcare systems. This study has thereby
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introduced a personalised approach of the MobileCoach to firstly identify the needs of the
participants to customize the treatment for them as a way of improving the ability of
MobileCoach based DHI’s (Babl and et. Al., 2008). This personalised method has been further
demonstrated by an example of DHI for asthmatic patients by detecting their coughing with
assistance of a microphone installed smartphone. This was found to be a successful attempt with
83% accuracy in detecting 80 coughs. This depicted a feasible technicality of DHI where next, it
is aimed to focus upon the integration of tailored sensing and applications for support.
Another study conducted by Wise, M. and et. Al. (2007) has demonstrated the efficacy of
internet telehealth in managing the case of pediatric asthma with a special context of children
aged 4 to 12 years. This has reviewed the integration of several computerised features for
designing a web based education program for managing asthma. It is however intended to
involve the parents and educate them to manage the state of asthma in their children aged in the
range of 4- 12 years and is suffering from moderate to severe level of asthma. It was specially
carried out for US based children who have a higher chance of suffering from asthma attacks
every year. Asthma is one of the most chronic childhood ailment in US.
The current study involved the personalization of various computer based custom-made
messages, along with a human coach to construct the skills of asthma self-management in the
users. It together involved several computer- based features such as Asthma manager, My goals,
My calendar, a custom-made homepage and My reminder, combined with monthly phone calls
for asthma education from an nurse case manager of asthma (Huckvale and et. Al., 2015). This
study has depicted the involvement of a randomized assessment to discourse upon the
developmental procedures and issues related to the proposed intervention. Lastly, it has been
tested to verify its adherence to an everyday asthma supervisor medication for controlling the
state of asthma in children by together providing a quality life to the parents as a way of reducing
the utilisation of asthma related healthcare.
Voncken-Brewster and et. Al. (2014) with assistance of a pilot study have reviewed the
integration of a tailored eHealth self-management application. It is however with a special
consideration of those suffering from chronic obstructive pulmonary disease (COPD) in primary
care. It involved 6 practicing nurses with individual patient to train them in the management of
COPD. This study depicted a mixed method to examine the eHealth application with the help of
a questionnaire. It is with a main aim of capturing the demographic data of the participants along
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with their behaviours related to self-management and determinants as well as recommendations
given by the nurses. This study mainly involved 11 patients under 3 nurses to use the designed
application for 1-7 times. It recorded a diminishing interest of the patients after using it for
multiple time. Although, it also demonstrated the outcome of customised feedback to the patients
in the form of messages and reports to the involved set of nurses. Herein, a semi structured
interview was conducted with both the nurses as well as the patients to compute descriptive
statistics for quantitative data. Along with which, a content analysis was together done to assess
the obtained qualitative information.
Evidence shows that it is in favor of self management for asthma. More specifically, it
includes provision of written asthma action plan and is supported with medical reviews. When
control of asthma is made under supervision, then it becomes helpful to make sure the areas in
which the patient need to have development. This way the medical support that one gets through
application is helpful enough to overcome them and to live a healthy life (Wiecha and et.al.,
2015). However, it is the responsibility of the healthcare to make sure that appropriate
information use of these are made. When this is done, then it makes easy for the patients analyse
the data and get an appropriate steps to overcome them in effective manner.
RESULTS
In accordance with database search made there were in total 677 articles that were
identified. Among which 654 were excluded as there were not matching with the title. From the
remaining 23, 9 of them were removed due to its abstract and from the remaining 14, 4 of them
were removed as it did not provided sufficiency information. This way, total 10 of the articles are
used in covering all these areas in appropriate manner.
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The result identified by Voncken-Brewster, V. and et.al., (2014) the subject to current
work is formed from coughing detection module through MobileCoach in order to provide
personalization. In accordance with the module that is developed, it is based on classification of
spectral features by making use of audio signal implementation. Instead of simple decision tree
classification, vector machine classification is used. This was helpful enough to provide better
result in terms of specificity, sensitivity and accuracy in relation with the settings. At the initial
stage 5 respondents were selected and the recording was done by making use of bespoke app.
The test found 16 intentional coughs instead of natural coughs. In the app, participants were
asked to read within limited amount of time. This was helpful enough to build non-coughing and
coughing data, this way a predicting data was learned. The data showed up to 83.3% of accuracy.
From the result, it can be stated that the application will enable to change the perception of
asthma. Generally it is identified that people are scared with any type of diseases that are faced.
However, when the application is used, then it becomes favourable enough to make analysis of
the increase of decrease in the health condition of patients.
The result conducted by Gustafson, D. and et.al., (2012), they made use of e-Health
application for which 11 participants were selected. As per the perception of the respondents it is
identified that the application supports self management but the rate of interest decreased with
multiple uses. Determination of patient’s health could not be done because of small sample size.
On the other hand, nurses were able to get benefited through it and also provided suggestions to
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optimize its use. The method applied by researchers are not effective enough as the total
respondents who are selected in this process was 11 and this is not enough samples on which the
result can be relied on. Even in this findings, the data is not sufficient to provide reliable data but
still that findings show that the applications enable to deliver efficiency information in relation
with the health condition of the patient and thus they take up steps and follow strategies to
overcome them.
As per the result identified by Barata, F. and et.al., (2016), it was identified that the
applications that was implemented was effective enough as it covers all the important areas with
the help of which information was provided to patients. Further, it was also helpful enough in
contacting with the doctors or professional who were help enough to provide valuable
information. All these helped the patients to take up immediate steps through which the rate of
negative impact can be reduced. Further, the result shows that all majority of the users of
applications were facing issues in relation with making use of the app in appropriate manner.
This way, the result that was expected was not attained.
DISCUSSION
From the analysis made, it can be stated that the rate of opportunities that patients with
asthma gets is high. With time, there are many changes that have taken place in relation with
technology. Majority of people make use of mobile phones that are supported by software’s. In
this context, this is software that is developed by health care firms are helpful enough to consider
the issues that are faced from the side of patients (Schubart and et.al., 2011). As per the data that
is identified, there are about 4 million children who are facing issue of asthma attacks each year.
This increasing rate can be controlled by considering the use of application that is helpful to
management and direct all the requirements that are made by asthmatic patients. there are many
researches that are carried out by various researchers and all these are helpful to make sure that
he rate of support from the side of health care can be raised. There are conditions identified in
which the rates of understanding and knowledge that people have are low for asthma and the
type of treatment that will enable to support them through this is also low. However, with the
help of applications, it enables to analyse the condition of people with asthma by making them
read dome line within short time and when they cough, then recording is done (Stewart and et.al.,
2011). When this is done, then it becomes favourable enough get medical support and in
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determining the steps that can be to overcome them. The data enables to identify the areas in
which improvement can be made and the conditions that are faced through which the rate of
problems that are faced can be solved. Majority of people think that through applications, it helps
to focuses on the cough that is taken by the patient and consideration is also make in getting
information from the side of patients.
CONCLUSION
From the findings made through this report, it can be started that preferences that are
made by people towards application are high. There are many benefits that individuals get
among one of the main benefit is related with time saving. All the information that patients need
to have is provided by the application as per the health condition of the patient. Further, this also
have effective benefit towards reducing the negative issues that are faced. There are many people
who think that with use of application they are able to monitor their health conditions and in
taking up help and support from professionals. In addition to this, the uses of application are only
effective when all people are able to make use of the application in effective manner. Moreover,
the health care organizations that is willing to develop application of asthmatic patients, then
they have to make it easy so that each person can get benefited.
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REFERENCES
Books and Journal
Babl, F. E. and et. Al., 2008. Paediatric acute asthma management in Australia and New
Zealand: practice patterns in the context of clinical practice guidelines. Archives of
Disease in Childhood. 93. pp. 307-312.
Barata, F. and et.al., 2016, September. Personal MobileCoach: tailoring behavioral interventions
to the needs of individual participants. In Proceedings of the 2016 ACM International
Joint Conference on Pervasive and Ubiquitous Computing: Adjunct (pp. 1089-1094).
ACM.
Gustafson, D. and et.al., 2012. The effects of combining Web-based eHealth with telephone
nurse case management for pediatric asthma control: a randomized controlled trial.
Journal of medical Internet research, 14(4).
Huckvale, K. and et. Al., 2015. The evolution of mobile apps for asthma: an updated systematic
assessment of content and tools. BMC Medicine. 13. 58.
Pinnock, H., 2015. Supported self-management for asthma. Breathe, 11(2), p.98.
Schubart, J. R. and et.al., 2011. Chronic health conditions and internet behavioral interventions: a
review of factors to enhance user engagement. CIN: Computers, Informatics, Nursing,
29(2), pp.81-92.
Stewart, M. and et.al., 2011. Online solutions to support needs and preferences of parents of
children with asthma and allergies. Journal of family nursing, 17(3), pp.357-379.
Voncken-Brewster, V. and et. Al., 2014. Integrating a tailored e-health self-management
application for chronic obstructive pulmonary disease patients into primary care: a pilot
study. BMC Family Practice. 15. pp. 4.
Wiecha, J. M. and et.al., 2015. Evaluation of a web-based asthma self-management system: a
randomised controlled pilot trial. BMC pulmonary medicine, 15(1), p.17.
Wise, M. and et. Al., 2007. Internet Telehealth for Pediatric Asthma Case Management:
Integrating Computerized and Case Manager Features for Tailoring a Web-Based Asthma
Education Program. Health Promotion Practice. 8(3). pp. 282–291.
Online
Barata, F., Kowatsch, T. and Tinschert, P., 2016. Personal MobileCoach: Tailoring Behavioural
Interventions to the Needs of Individuals Participants. [PDF]. Available through:
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<http://cocoa.ethz.ch/downloads/2017/02/2260_Barata%20et%20al
%202016%20Personal%20MobileCoach.pdf>.
Corderoy, A., 2014. Australia has one of highest rates of asthma in the world. [Online].
Available through: <https://www.smh.com.au/national/australia-has-one-of-highest-rates-
of-asthma-in-the-world-20141118-11oybk.html>.
Pluddemann, A., 2018. Self-management of asthma – is there an app or pulse oximeter for that?.
[Online]. Available through: <http://blogs.bmj.com/bmjebmspotlight/2018/01/04/self-
management-asthma-app-pulse-oximeter/>.
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