A theory-, evidence- and person-based approach to developing a digital intervention for adolescents with asthma

Abstract

Despite appropriate pharmacotherapy, young people with asthma often suffer with poor quality of life. Dysfunctional breathing co-exists alongside asthma and can exacerbate breathing symptoms and lead to feelings of panic. A digital intervention has previously been demonstrated as an effective tool to improve quality of life in adults with asthma. However, adolescents are in a distinctive developmental period, transitioning into adulthood and the tool was required to be repurposed to create a health intervention that targets the needs of a younger audience.

In this thesis, a theory, evidence and Person-Based Approach was used to co-develop a self-management intervention with key stakeholders including clinicians, physiotherapists, and public contributors. Detailed intervention planning explored key issues, needs and challenges of adolescents with asthma. A scoping review, qualitative interviews and theoretical mapping were used to explore barriers and facilitators to the intervention and to identify behaviour change techniques to address these needs. Barriers identified included over-reliance on quick relief inhalers, embarrassment in public settings, difficulty remaining calm, and forgetfulness. Facilitators included relatable peer-led demonstration videos, discretion of techniques, understanding the rationale of exercises, personalised reminders, visual stimuli, and limits on reading burden. Modifications were made to a prototype intervention during an optimisation phase based on further rich feedback from target users. An engaging, accessible, and intuitive mobile-based website was developed. A pilot trial demonstrated that a Phase III trial is likely to be acceptable and feasible. A mixed methods process evaluation gave insights into potential contextual features that may influence intervention use such as use of reminders.

Overall, a self-guided breathing retraining intervention has been developed based on key behavioural issues and needs of adolescents with asthma. The findings may be used to optimise interventions that address the needs of this typically under-served group and to conduct a definitive trial to explore the (cost)effectiveness of the intervention.

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Identifiers

ORCID for Graham Roberts: orcid.org/0000-0003-2252-1248

ORCID for Ben Ainsworth: orcid.org/0000-0002-5098-1092

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