Asthma and Technology in Emerging African American Adults (The ATHENA Project)

哮喘在美国造成相当大的发病率和死亡率，特别是在新兴的非裔美国人中 成人(AAEA；18-30岁)，但很少有哮喘项目针对这一人群。干预措施 提供教育和解决哮喘管理的潜在动机可能是最有效的。然而， 密集的面对面干预往往很难实施，特别是在新兴成年人中。这个 这项建议的目的是开发有效的移动式哮喘管理干预措施，以改善控制 在AAEA。我们将评估多个技术组件帮助和改进传统技术的能力 哮喘教育：1)MES。哮喘管理的激励增强系统(MES)是一种 利用支持的自我调节和动机访谈(MI)的移动4次会议干预。 个性化内容基于每个参与者的活动水平、日常体验和目标。2)SA。 支持性责任(SA)由哮喘护士利用定向移动支持(Skype/语音)实施 呼吁)提供教育，促进自我效能，并通过以MI为基础的框架克服障碍。3) 短信。短信(短信)为哮喘教育、服药依从性和体检提供提醒 活动。4)PAT.身体活动跟踪(PAT)使用可穿戴技术来帮助满足用户定义的身体 活动目标。使用多阶段优化策略(MOST)框架，我们将测试这4种干预 组件和组件组合，以确定最有效的移动干预。MOST是一种 创新、经济、省时的框架，利用工程原理生产有效的 行为干预。我们将使用析因研究设计进行成分选择实验 建立一种经过优化以实现最大疗效的干预措施。我们将使用一种具有临床意义的 改善哮喘控制，作为确定哪些成分应保留在 优化干预。参与者(N=180)将被随机分配到6个干预组中的1个，其中包括 干预组件的各种组合。这个实验设计相当于 多个试点随机临床试验来评估每个成分的疗效，但只使用了一小部分 样本大小和资源。在研究完成后，我们将有一个有经验支持的， 优化流动哮喘管理干预，提高AAEA对哮喘的控制水平。参与者将是 从美国肺脏协会呼吸道临床研究中心网络的多个站点招募 底特律医疗中心的门诊护理诊所。数据收集将在基线3、6和12进行 月份。我们假设在干预后(3、6和12个月)，患有未控制哮喘的参与者将 临床上显示哮喘控制有显著改善。我们假设哮喘的改善 管理行为(包括体力活动)、生活质量、症状、坚持和恶化 (次要结果)也将观察到。

Asthma causes substantial morbidity and mortality in the U.S., particularly among African American emerging adults (AAEA; ages 18-30), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be most effective. However, intensive, face-to-face interventions are often difficult to implement, especially among emerging adults. The purpose of this proposal is to develop an effective mobile asthma management intervention to improve control in AAEA. We will assess the ability of multiple technologic components to assist and improve traditional asthma education: 1) MES. The Motivational Enhancement System (MES) for Asthma Management is a mobile 4-session intervention utilizing supported self-regulation and Motivational Interviewing (MI). Personalized content is based on each participant’s activity level, daily experiences, and goals. 2) SA. Supportive accountability (SA) is administered by asthma nurses utilizing targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through an MI-based framework. 3) SMS. Text messaging (SMS) provides reminders for asthma education, medication adherence, and physical activity. 4) PAT. Physical activity tracking (PAT) uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test these 4 intervention components and combination of components to identify the most effective mobile intervention. MOST is an innovative, cost- and time-effective framework that utilizes engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy. We will use a clinically significant improvement in asthma control as the criterion for determining which components should be kept in the optimized intervention. Participants (N=180) will be randomized to 1 of 6 intervention arms consisting of various combinations of the intervention components. This experimental design is equivalent to conducting multiple pilot randomized clinical trials to evaluate the efficacy of each component, yet uses only a fraction of the sample size and resources. At the completion of the study, we will have an empirically-supported, optimized mobile asthma management intervention to improve asthma control for AAEA. Participants will be recruited from multiple sites of the American Lung Association Airway Clinical Research Center network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, 3, 6, and 12 months. We hypothesize that post-intervention (3, 6, and 12 months), participants with uncontrolled asthma will show clinically-significant improvement in asthma control. We hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbations (secondary outcomes) will also be observed.