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

在美国，哮喘导致大量的发病率和死亡率，特别是在非洲裔美国人中， 成人（AAEA;年龄18-30），但很少有哮喘项目针对这一人群。的干预措施 提供教育和解决管理哮喘的潜在动机可能是最有效的。然而，在这方面， 密集、面对面的干预措施往往难以实施，特别是在新成年人中。的 本提案的目的是开发一种有效的移动的哮喘管理干预措施，以改善控制 在AAEA。我们将评估多个技术组件协助和改进传统 哮喘教育：1）MES。哮喘管理的激励增强系统（MES）是一个 移动的4次干预，利用支持的自我调节和动机访谈（MI）。 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. 哮喘护士利用有针对性的移动的支持（Skype/语音）实施支持性问责（SA 呼吁）提供教育，提高自我效能，并通过基于MI的框架克服障碍。第三章 短信。短信（SMS）提供哮喘教育、药物依从性和身体检查的提醒。 活动4)专利身体活动跟踪（PAT）使用可穿戴技术来帮助满足用户定义的身体活动。 活动目标。使用多阶段优化策略（MOST）框架，我们将测试这4种干预措施 组件和组件的组合来识别最有效的移动的干预。MOST是一个 创新的、具有成本效益和时间效益的框架，利用工程原理， 行为干预。我们将使用析因研究设计进行成分选择实验 来建立一个最优化的干预措施，以获得最大的疗效。我们将使用具有临床意义的 哮喘控制的改善作为确定哪些成分应保留在 优化干预。受试者（N=180）将被随机分配至6个干预组之一，包括 干预组件的各种组合。这种实验设计相当于进行 多个试点随机临床试验，以评估每种成分的疗效，但只使用一小部分， 样本量和资源。在研究完成后，我们将有一个得到专家支持的， 优化移动的哮喘管理干预，以改善AAEA的哮喘控制。参与者将被 从美国肺脏协会气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。将在基线、3、6和12时收集数据 个月我们假设干预后（3、6和12个月），哮喘不受控制的参与者将 在哮喘控制方面显示出临床上显著改善。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、依从性和加重 （次要结果）也将被观察。

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.