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Title: Information technology supported approaches to medication adherence : the use of mobile applications
Author: AlQahtani, Fahad Masfer
ISNI:       0000 0004 6060 9416
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2016
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Adherence to inhaled treatment is considered an important basic aspect of asthma management. However, poor adherence to, and improper technique in, the use of inhalers is prevalent in asthma patients (including children) and is associated with increased morbidity. The high human and cost burden of asthma to society demands effective interventions to promote desired treatment outcomes. The main focus of the research presented in this thesis was on the application of mobile IT technologies in direct observation of therapy (DOT) to help improve inhaler use and adherence in children with asthma. Whereas a rapid systematic review indicated that this "mobile DOT’ (MDOT) approach was focused to date on only two disease states, i.e. TB and sickle cell disease, in the present research a new MDOT application (app) was developed "in house’ to monitor inhaler technique in children with asthma. The performance of the app was first tested in healthy volunteer children (n=12, aged 2 to 12 years old) in a feasibility study over a period of two weeks. Parents (and older children) were asked to submit videos, via their mobile device (smartphone or tablet), twice daily of the child’s use of a dummy inhaler and to submit this via wifi to a secure digital repository for evaluation. The app was found to work well and was well accepted by both children and parents. Following these positive findings a pilot clinical trial was conducted in children with asthma (n=22; age range 2 to 16 years old) whose condition was not well controlled using optimised pharmacotherapy. The results of this latter clinical study confirmed the feasibility study findings, i.e. the app was easy to use and was well accepted by participants. The MDOT intervention lasted 6 weeks in the children with asthma, with monitoring of outcome measures undertaken at baseline, 6 weeks and 12 weeks (i.e. 6 weeks post initial implementation of the MDOT programme). Although adherence was estimated at approximately 40% using the rate of video uploads (an average of one upload per day over the six week monitoring period was the conservative measure used) in general asthma related outcome measures improved at 6 and 12 weeks post initiation of the intervention, i.e. decreased lung inflammation (as measured by FeNO), improved self-reported adherence (MARS questionnaire) and improved asthma control (as measured by the ACT Z C-ACT questionnaire). Health related quality of life also improved in both children (PACQLQ questionnaire) and their parents (PAQLQ questionnaire). Part of the success of the MDOT intervention was due to the ability of the healthcare team to view videos and provide feedback to participants on improving inhaler technique, as required. The latter was required particularly in the early phase of the intervention. Healthcare providers also contacted participants to discuss adherence issues if videos were not uploaded at the expected times, i.e. if no videos were uploaded for two consecutive days. This pilot study provides the framework and preliminary data to support the launch of a larger, multicentre trial using the MDOT app developed as part of this research programme. In a final experimental chapter of the thesis, mobile app use and availability more generally was investigated via carrying out a content analysis of newspaper articles in highly circulated newspapers in the US and UK. Most of the apps being brought to the attention of the public via this mass media outlet were aimed at lifestyle enhancement, e.g. fitness and healthy eating, rather than on specific diseases. Diabetes apps were the most commonly discussed from a disease perspective with asthma related apps very much in the minority. As hypothesised the newspapers generally reported benefits of app use rather than potential harms / risks (e.g. access to personal data by an unauthorised third party). There is therefore much scope for the further development of the current MDOT app and indeed other apps for the common illness of childhood asthma.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available