Despite the availability of potent medical treatment and effective self-management strategies, there is a significant burden of asthma among adolescents. Information and communication technology (ICT), such as internet and short message service (SMS), is an emerging tool in asthma management. Therefore we aimed to elicit barriers of well and poorly controlled adolescents to current asthma management and their views on barriers and benefits of internet based self-management.
Ninety-seven adolescents (12-17 yr) who had mild to moderate persistent asthma (> 3 mo inhaled corticosteroid usage in the past year) were asked to monitor asthma control on a designated website (weekly Asthma Control Questionnaire (ACQ); daily lung function (FEV1) registrations via website or SMS). After 4 weeks, 35 patients participated in 8 focus group interviews stratified on sex, age and asthma control (well controlled: ACQ-score < 1 and no control problems according to the Asthma Therapy Assessment Questionnaire (ATAQ); poorly controlled: ACQ>=1 and >= 1 ATAQ control problem). Focus group interviews were audiotaped, fully transcribed and coded with respect to the four components of asthma self-management. The findings were qualitatively and quantitatively analyzed.
Limited perceived ability to control asthma was a significant barrier in adolescents with poor asthma control compared to well controlled participants (p<0.01). The former group revealed several benefits from internet based asthma self-management: feasible electronic monitoring and feedback, easily accessible comprehensive information, email communication and use of an electronic action plan. Personal benefits included the ability to react to change and optimize asthma control and the possibility to limit face-to-face medical review. Poorly controlled participants were able and ready to incorporate internet based asthma self-management into their daily lives, whereas well controlled participants did not consider this appropriate for a long period of time (p<0.01).
Our findings elicit that there is a need to overcome limited perceived ability (self-efficacy) in current asthma management of adolescents with poor asthma control. Internet based self-management appears to be a powerful tool to overcome limited self-efficacy in this group of patients. In contrast to well controlled adolescents poorly controlled participants are willing and able to use a guided self-management programme including internet and short message service over a long period of time. Internet based self-management should therefore target poorly controlled adolescents with asthma.