Effect of a mHealth intervention on adherence in adolescents with asthma: A randomized controlled trial

Background: Adherence rates among asthma patients are generally low and decrease during adolescence, resulting in poorly controlled asthma. The aim of our study was to evaluate the effectiveness of the ADolescent Adherence Patient Tool (ADAPT), an interactive mobile health (mHealth) intervention, in supporting self-management and improving inhaled corticosteroid adherence in adolescents with asthma. Methods: We conducted a cluster randomized controlled trial in 66 Dutch community pharmacies. Asthma patients aged 12-18 years were invited to participate, based on pharmacy medication refill records. The main study outcome was self-reported medication adherence, measured with the Medication Adherence Report Scale (MARS). Secondary outcomes were asthma control and quality of life. Outcomes were measured at start (t=0 months) and at the end of follow-up (t=6 months). Mixed-effects models were used to analyze the effect. Results: In total, 234 adolescents (147 in the control group and 87 in the intervention group) completed the study; mean age 15.1 +/- 1.9 years and 52.6% females. Adherence rates of patients with low baseline adherence (MARS scores <= 19; n=76) increased with 1.42 points in the intervention group (n=26). Adherence rates of patients in the control group (n=50) decreased with 0.70 points. Thus there was a positive effect of the intervention on medication adherence (MARS +2.12, p=0.04). This effect was stronger (MARS +2.52, p=0.02) in poor adherent adolescents with uncontrolled asthma (n=74). No effect of the intervention was observed on asthma control or quality of life. Conclusions: The ADAPT intervention increases medication adherence in adolescents with asthma having poor adherence rates at baseline. Healthcare providers should consider a tailored mHealth approach to improve the asthma treatment.