Interactive applications for patient education and behaviour change in asthma

1. Interactive applications for patient education and behaviour change in asthma Introduction to Medicine Class 16 2006-2007

2. Summary • Introduction • Aim • Methods • Study Design • Definition of population • Clinical outcomes evaluated • Search strategy – Query • Inclusion/Exclusion criteria • Results • Discussion • Limitations of our study • Conclusion • Gantt Chart • Site Map

3. Introduction

4. Introduction ASTHMA • chronic disease • recurrent breathlessness and wheezing • high prevalence all over the world • undesired clinical outcomes • treatment strategies • improve asthma outcomes World Health Organisation (WHO) Gina Report: Global Strategy for Asthma Management and Prevention

5. Introduction • Strategies : acquire self-efficacy and information • Patient education with interactive application • Interactive applications (IA) - computer-based, usually web-based, information packages for patientscombine health information, social supportdecision, or behaviour change • Guevara J.P., BMJ. 2003 • Clark NM, BMJ. 2000 • Murray E., CDSR 2005 • Overcome difficulties

6. Introduction - Aim • To summarize the results from published studies about the use of interactive applications for education of children and/or adults with asthma; • Research Question: • Are clinical outcomes achieved with the use of interactive applications better than with usual care?

7. Methods

8. Study Design • Systematic Review: Combine the available evidence from published studies to draw more reliable and generalised conclusions.

9. Definition of the Population • Articles indexed in MedLine inclusively, identified through a sensitivy query related to the use of IA in asthma care

10. Variables • Number of people with outcomes

11. Clinical outcomes evaluated • Score of quality of life • Lung functions • Frequency of symptoms • Hospital admitions • Absenteeism to work/school • Emergency room visits • Asthma knowledge • Self-management • Medication • Physician consultation

12. Search Strategy - Query (("asthma"[MeSH Terms] OR asthma[Text Word])) AND ((interactive[All Fields] AND ("communication"[MeSH Terms] OR communication[Text Word]) AND applications[All Fields]) OR computerized[All Fields] OR (telemedicine[MeSH Terms] OR telemedicine[Text Word]) OR (("computers"[TIAB] NOT Medline[SB]) OR "computers"[MeSH Terms] OR computer[Text Word]) OR ("internet"[MeSH Terms] OR internet[All Fields]) OR ("software"[MeSH Terms] OR software[Text Word]) OR ("multimedia"[MeSH Terms] OR multimedia[Text Word]) OR ("hypermedia"[MeSH Terms] OR hypermedia[Text Word]) OR (www[All Fields] OR web[All Fields] OR online[All Fields]) OR e-health[All Fields] OR video[All Fields] OR digital[All Fields] OR ("television"[MeSH Terms] OR television[Text Word]) OR video[All Fields] OR audio[All Fields]) AND ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading]) AND ((("patient education"[MeSH Terms] OR patient education[Text Word]) OR (educational[All Fields] AND interventions[All Fields]) OR (psycho-educational[All Fields] AND interventions[All Fields]) OR ("self care"[TIAB] NOT Medline[SB]) OR "self care"[MeSH Terms] OR self management[Text Word]) OR prevention[Text Word]) OR (behavioral[All Fields] AND change[All Fields])

13. Inclusion Criteria • Controled studies that evaluate the eficacy of interactive aplication for asthma pacient education

14. Exclusion Criteria • Articles that were not in English, Portuguese and Spanish. • Non-access to the full text of the articles after : Library Search, Web search, contact withauthor and field experts;

15. General description of methods • We formulated a query and conducted an exhaustive search in PubMed; • The articles were distributed by groups of two people; • The title and abstract of articles were read and it were applied the inclusion and exclusion criteria in order to exclude or non-exclude it; • If the two elements of the group did not reach a consensus, the article is evaluated by a third element;

16. General description of methods • In a second step the full articles were distributed by groups of two people; • Full text of articles were read and the inclusion and exclusion criteria were applied; • In cases that the two elements of the group did not reach a consensus the article was evaluated by a third element;

17. Analysing Full Texts • Which clinical outcomes were evaluated? • What was the method of evaluation of the outcomes? • How long was the intervention? • What and how was the intervention? • Which results were obtained? • What is the main message of the article?

18. General description of methods • We extracted the data from the selected articles and inserted it on SPSS; • We conducted a data analysis; • We interpreted and discussed our results;

19. Results Selection of participants

21. Included Vs Excluded Articles Add

22. Lesser exclusion motive

23. Agreement between evaluators

24. Reviewer1 * Reviewer2 Crosstabulation Count Symmetric Measure a. Not assuming the null hypothesis. b. Using the asymptotic standard error assuming the null hypothesis.

25. Analysing full text

26. Interactive application used • Three types of interactive applications were more frequently used: computer programs, video games, web-based education program.

27. Follow up time

28. Number of individuals of the population per study

29. Significantly improvement of the treatment group vs control group* + Significantly improvement of the control group* vs treatment group - 0 Not significantly differences between the two groups *The control group also have a paralell intervention (not interactive)

30. Summary of results of the studies • Only in one study the allocation of patients to control and exposed groups was not random. • Six of thirteen studies evaluated acquisition of asthma knowledge and five of this observed better results on intervention group compared with control group while one did not observed significantly differences. • Ten out of the thirteen studies generally concluded that the outcomes of individuals using interactive applications were better than in control groups.

31. Discussion • Interactive applications often achieve positive outcomes in the target populations • Computer programs is the type of interactive application most investigated. • Web-based programs are less studied but have better results in most patients’ outcomes. • The results of other interactive applications are inconsistent.

32. Discussion • Computer program: • There is some heterogeneity in the results, but the majority of the cases lead to several improvements. • However, since some articles show that the control group had better results than the intervention group, it is necessary to evaluate this intervention in more studies so as to lead to solid conclusions.

33. Discussion • Video game: • There are contradictory results, so more studies about this method must be performed in order to have a better evaluation. • Web-based education program: • Although only two articles are currently available, significant improvements were observed in the target population.

34. Discussion • GSM and SMS : • More studies are necessary since the only article with this interactive method reported good results in pulmonary function and self-management. • Program connected to a home telephone: • Only one article was found, moreover its results were not consistent, with improvements in emergency visits, school absence and quality of life but with negative results as for hospital admissions.

35. Discussion • In general, the outcomes with more considerable improvements were knowledge about asthma, absenteeism and the need of medication. • This can be explained since these applications, by using methods like games that are more attractive to a young population, may allow them to learn more efficiently with this kind of approach. • The adult’s population is not so open to these interactive methods. • On the contrary, as for the more practical results such as asthma severity, quality of life or even emergency visits, there is not, in general, a significant improvement. This may seem a paradox since the theoretical knowledge has improved.

36. Limitations of our study • It was not possible to perform a comparison among some studies because there were articles that studied the same interactive aplications but whose outcomes evaluated were different. • It is also important to mention that some of the articles that studied the effect of computer programs had a time of intervention superior than others.

37. Limitations of our study • Relatively to the number of participants: • there was a discrepancy among some studies and there was not a strong representation of the whole asthmatic population since 9 studies were about young children and only 4 about adults.

38. Limitations of our study Having in mind cited limitations Is not possible at this time to establish the usefulness of interactive methods for education and behaviour change of asthma patients.

39. Conclusion • The theme of this systematic review is a recent subject and still has many limitations: • It is necessary to find ways of increasing adherence of participants in the studies and, as interactive applications are widely used by younger people, this can affect the results when we compare studies with adults versus studies with children. • The results from the articles included in this systematic review are very diverse

40. Conclusion • The use of interactive applications seem to be promising for improving patient education and promoting behaviour change, but more studies on the best options and on its effects in asthma outcomes are necessary. • Moreover, more studies about the use of interactive applications that account for the specific needs of each individual could be the purpose of new studies. • Asthma can severely affect the patients’ lives in different manners. In consequence, every effort maid with the aim of improving patient education and promoting behaviour change (increasing self-management) is meaningful and necessary.

41. Gantt Chart

42. Site Map

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44. Authors • Almeida P, Caetano F, Carvalho A, Fernandes S, Gaspar J, Loureiro M, Marques C, Neves N, Rollo A, Sousa C, Sousa C, Sousa S. • Supervisors • Fonseca, MD, PhD

45. Questions