School-based telehealth (SBTH) plays a valuable role in child asthma management, although nurses have concerns with caregiver engagement. Mobile technology (m-health) has potential to improve this engagement.
Objective:
We identified barriers and key desired features of an asthma m-health application as a supplement to an existing SBTH asthma program in rural settings.
Methods:
Multimethod design using school nurse surveys and interviews with school and SBTH personnel to describe processes related to implementation of an m-health application.
Results:
Nurses reported SBTH programs were an ideal setting to identify potential families for m-health. Benefits of caregiver education and engagement and barriers related to technology, smart phone data availability, and family buy-in were described. Desired application features included education on inhaler technique, asthma symptom, and medication adherence reports.
Conclusions:
The feedback identified from nurses can be incorporated into an asthma m-health program within an SBTH program to facilitate implementation.
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References
1.
EstradaR, OwnbyD. Rural asthma: Current understanding of prevalence, patterns, and interventions for children and adolescents. Curr Allergy Asthma Rep, 2017; 17:37.
2.
FedeleD, BarnettT, EverhartR, LawlessC, ForrestJ. Comparison of asthma prevalence and morbidity among rural and nonrural youth. Ann Allergy Asthma Immunol, 2016; 117:193–194.
3.
OwnbyD, TingenM, HavstadS, WallerJ, JohnsonC, JosephC. Comparison of asthma prevalence among African American teenage youth attending public high schools in rural Georgia and urban Detroit. J Allergy Clin Immunol, 2015; 136:595–600.
4.
GarciaE, SerbanN, SwannJ, FitzpatrickA. The effect of geographic access on severe health outcomes for pediatric asthma. J Allergy Clin Immunol, 2015; 136:610–618.
5.
PerryT, RettigantiM, BrownR, NickT, JonesS. Uncontrolled asthma and factors related to morbidity in an impoverished, rural environment. Ann Allergy Asthma Immunol, 2012; 108:254–259.
6.
WuC, AndrewsA, TeufelR, BascoW. Demographic predictors of leukotriene antagonist monotherapy among children with persistent asthma. J Pediatr, 2014; 164:827–831.
McSwainS, BernardJ, BurkeB, et al.American Telemedicine Association operating procedures for pediatric telehealth. Telemed J E Health, 2017; 23:699–706.
9.
BianJ, CristaldiK, SummerA, et al.Association of a school-based, asthma-focused telehealth program with emergency department visits among children enrolled in South Carolina Medicaid. JAMA Pediatr, 2019; 173:1041–1048.
10.
HaltermanJ, FagnanoM, TajonR, et al.Effect of the school-based telemedicine enhanced asthma management (SB-TEAM) program on asthma morbidity: A randomized clinical trial. JAMA Pediatr, 2018; 172:e174938.
11.
WoodardG, TriplettN, MartinP, et al.Implementing mental health services for children and adolescents: Caregiver involvement in school-based care. Psychiatr Serv, 2020; 71:79–82.
12.
MacGeorgeCA, KingKL, SimpsonAN, AbramsonEL, et al.Comparison of attention-deficit/hyperactivity disorder care between school-based health centers and a continuity clinic. J Sch Health, 2019; 89:953–958.
13.
MacgeorgeCA, CristaldiKK, AndrewsAL, et al.School nurse perception of asthma care in school-based telehealth. J Asthma, 2021;[Epub ahead of print];DOI:10.1080/02770903.2021.1904978.
14.
TeufelR, PatelS, ShulerA, et al.Smartphones for real-time assessment of adherence behavior and symptom exacerbation for high-risk youth with asthma: Pilot study. JMIR Pediatr Parent, 2018; 1:e8.
15.
VerdonschotA, De VetE, Van SeetersN, et al.Caregivers' role in the effectiveness of two Dutch school-based nutrition education programmes for children aged 7–12 years old. Nutrients, 2021; 13:140.
16.
NicholsM, MillerS, TreiberF, RuggieroK, DawleyE, TeufelR. Patient and parent perspectives on improving pediatric asthma self-management through a mobile health intervention: Pilot study. JMIR Form Res, 2020; 4:e15295.
17.
SAS Software. SAS Statistical Software, 2016. Available at https://sas.com (last accessed September15, 2020).
18.
TongA, SainsburyP, CraigJ. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care, 2007; 19:349–357.
19.
SaundersB, SimJ, KingstonT, et al.Saturation in qualitative research: Exploring its conceptualization and operationalization. Qual Quant, 2018; 52:1893–1907.
20.
NVivo Software. NVivo Qualitative Software. QSR International, 2016. Available at http://www.qsrinternational.com (last accessed August30, 2020).
21.
DoyleL, McCabeC, KeoghB, BradyA, McCannM. An overview of the qualitative descriptive design within nursing research. J Res Nursing, 2020; 25:443–455.
22.
SandelowskiM.Whatever happened to qualitative description?. Res Nurs Health, 2000; 23:334–340.
23.
SandelowskiM.What's in a name? Qualitative description revisited. Res Nurs Health, 2010; 33:77–84.
KorstjensI, MoserA. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract, 2018; 24:120–124.
26.
NowellLS, NorrisJM, WhiteDE, MoulesNJ. Thematic analysis: Striving to meet the trustworthiness criteria. Int J Qual Methods, 2017; 16:1–13.
27.
United States Department of Agriculture. USDA Rural Development, 2021. Available at https://ruraldevelopment.maps.arcgis.com/apps/webappviewer/index.html?id=15a73830555645ae93d2fa773ed8e971 (last accessed January25, 2021).
28.
AitkenM, LyleJ. Patient Adoption of mHealth. IMS Institute for Healthcare Informatics, 2015. Available at https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/patient-adoption-of-mhealth.pdf (last accessed February2, 2021).
29.
KagenS, GarlandA. Asthma and allergy mobile apps in 2018. Curr Allergy Asthma Rep, 2019; 19:6
30.
HuckvaleK, CarJ. Implementation of mobile health tools. JAMA, 2014; 311:1447–1448.
31.
BurbankA, LewisS, HewesM, et al.Mobile-based asthma action plans for adolescents. J Asthma, 2015; 52:583–586.
32.
MulvaneyS, HoY, CalaC, et al.Assessing adolescent asthma symptoms and adherence using mobile phones. J Med Internet Res, 2013; 15:e141.
33.
DhadgeN, ShevadeM, KaleN, et al.Monitoring of inhaler use at home with a smartphone video application in a pilot study. NPJ Prim Care Respir Med, 2020; 30:46
34.
VolermanA, DenninM, VelaM, IgnoffoS, PressVG. A qualitative study of parent perspectives on barriers, facilitators and expectations for school asthma care among urban, African-American children. J Asthma, 2019; 56:1099–1109.
35.
HollenbachJP, CushingA, MelvinE, McGowanB, CloutierMM, ManiceM. Understanding clinicians' attitudes toward a mobile health strategy to childhood asthma management: A qualitative study. J Asthma, 2017; 54:754–760.
