Understanding clinicians' attitudes toward a mobile health strategy to childhood asthma management: A qualitative study

ABSTRACT

Objectives: Mobile technology for childhood asthma can provide real-time data to enhance care. What real-time adherence information clinicians want, how they may use it, and if the data meet their clinical needs have not been fully explored. Our goal was to determine whether pediatric primary care and pulmonary clinicians believe if a sensor-based mobile intervention is useful in caring for patients with asthma. Methods: We recruited participants from 3 urban, primary care and 1 pulmonary practice from July to September 2015 in Hartford, CT. Forty-one participated in four focus groups, which included a demonstration of the technology. Participants were probed with open-ended questions on the type, frequency, and format of inter-visit patient information they found useful. Results: 41 participants (mean age 49 (±13.7) years) were board-certified clinicians (41% MDs and 20% mid-level practitioners), practiced medicine on an average of 19 (±14) years, were primarily white (59%) and women (78%). Clinicians wanted 1) adherence to prescribed inhaler therapy and 2) data on inhaler technique. Clinicians wanted it at the time of a scheduled clinic visit but also wanted inter-visit alerts for excessive use of rescue therapy. Pulmonologists liked the mobile spirometer's provision of inter-visit lung function data; pediatricians did not share this view. Concerns with data accuracy were raised due to families who shared inhalers, access to smartphones, and protection of health information. Conclusions: Overall, clinicians view an asthma mobile health technology as enhancing the patient-centered medical home. Pediatric primary care clinicians and pulmonologists want different information from a mobile app.

KEYWORDS:

• Adherence
• children
• mHealth
• self-management

Declaration of interest

Dr. Manice is the CEO and Co-founder of Cohero Health. Ms. Cushing is a full time medical student and part-time Clinical Project Manager for Cohero Health. Ms. Melvin is a Product Development Summer Associate for Cohero Health. Ms. McGowan is a Research Associate for Cohero Health. Dr. Hollenbach reports no financial support from Cohero Health. The relationship the corresponding author has with the Cohero Health entity is solely comprised of furthering the scientific understanding of the technology developed by Cohero Health. Dr. Hollenbach received no financial support from Cohero Health to conduct the studies outlined in this manuscript. Funds to conduct this study came from the Connecticut Children's Medical Center's Department of Research in the form of salary to support Dr. Hollenbach's research efforts in advancing the understanding and management of pediatric asthma. The sole purpose of having the CEO and Co-Founder of Cohero Health, Dr. Melissa Manice, present during the focus groups was to provide an expert overview of the mobile health app and technology on which the participants were to provide their perceptions and feedback. Dr. Manice did not participate as a facilitator of the focus groups, except for the sole purpose of answering questions regarding the technical capabilities of the product being discussed. Cohero Health did not provide any financial support for the facilitators to conduct the study.