Research and commentary

Exploring new methods of adherence assessment for asthma care

 Study looks at using an electronic monitoring device to measure adherence to treatment in young people with severe asthma

Study looks at using an electronic monitoring device to measure adherence to treatment in young people with severe asthma

Asthma
A spacer is one way of ensuring children receive adequate medicine into their lungs
Picture: Alamy

 

Ensuring that children and young people manage their asthma correctly is problematic and one method is to use an electronic monitoring device to measure adherence. A study by Stewart et al (2018) looks at this method for severe asthma. Here associate nursing professor Linda Milnes outlines the study and its implications for practice.

Stewart A, Gannon K, Beresford F et al (2018) Adolescent and caregivers’ experiences of electronic adherence assessment in paediatric problematic severe asthma. Journal of Child Health Care. 22. 2, 238-250. doi: org/10.1177/1367493517753082

Aim and method

This study draws on semi-structured interviews to explore young people’s experiences of using an electronic monitoring device to measure adherence to inhaled corticosteroids for asthma. More specific study questions concerned whether the device affected young people’s responsibility for asthma self-management, and the relationship between young people and healthcare professionals. Thematic analysis of the data was conducted.

Findings

Eight 11 to 15 year olds (five female, three male) and their caregivers (mothers) were interviewed. The children had used the electronic monitoring device between July 2014 and January 2015 as part of their clinical treatment for asthma. Individual interviews were conducted with each child and mother except for two interviews where they were interviewed together. Three themes were identified:

  1. They were trying to help me get better All participants had been referred to the hospital clinic with a diagnosis of severe asthma. They described the significant effect asthma had on their lives, their feelings of vulnerability and the risk of asthma being life-threatening. Their perceptions of the electronic monitoring device  included that it helped participants feel better, reduced the need for reliever inhalers and reduced hospitalisations.
  2. Checking up and catching up The young people described the device as a way for health professionals to check on their adherence to inhaled corticosteroids and thought the electronic monitoring device data replaced their own communication of self-management to health professionals.The mothers said the electronic monitoring device made them feel disbelieved by health professionals, but they welcomed the opportunity to check their child’s adherence when they were with other carers or friends. 
  3. Who is responsible? Although the aim of the device is to increase responsibility for self-management, young people described limited involvement in consultations and increased dependency on parents for reassurance that they were using the device correctly.

Conclusion

The electronic monitoring device may be useful in demonstrating to children and young people the health benefits of taking inhaled corticosteroids regularly. However, health professionals need to understand that the decision to use them should be based on the needs and perspectives of the adolescent and family.

Using electronic monitoring devices in a programme of asthma management could help promote independence

For young people, learning the skills to self-manage effectively provides a foundation for continuing healthy self-care behaviours into adulthood. However, the trajectory to independence in managing a long-term condition is not always linear for young people, who may continue to seek support or rely on advice from their carers.

Parents also find transferring responsibility of managing a long-term condition to their children challenging. Intermittent episodes of asthma exacerbations that lead to repeated hospital admissions, days off school and interruption of social support can influence young people’s trajectory to independence. So responsibility for the management of asthma sometimes needs to be shared with young people or require more support.

The complex and individual physical, psychological and social environment in which adolescents and families practice self-management should be taken into account to maximise the effect of interventions such as the electronic monitoring device.

The study shows the electronic monitoring device seems to increase adherence to inhaled corticosteroids to the extent that young people recognised the positive impact the medication has, although it should be noted the study’s sample size was small and the transferability of its findings therefore reduced.

Perhaps the use of the electronic monitoring device integrated in a full programme of individualised asthma self-management support designed specifically for young people would change the negative outcomes of this study.  


Linda Milnes is associate professor of children and young people’s nursing, school of healthcare, University of Leeds, on behalf of the RCN’s Research in Child Health community

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