Seminar Recap – Mobile phone-based asthma self-management aid for adolescents (mASMAA)

Did u take ur asthma meds?

Yes, thx. L8r.

Though the “no texting at the dinner table” rule might provide a brief respite, it’s hard to find a teenager these days who doesn’t have his or her face buried in a smartphone.

And while the ubiquitous devices have created another frustration for parents everywhere who are trying to connect with their children, researchers at the University of Rochester are tapping into the near-universal form of communication in the hopes of increasing teenagers’ ability to manage their asthma — and keeping their parents posted about it.


Hyekyun Rhee, Ph.D.

Hyekyun Rhee, PhD, an associate professor of nursing and pediatrics in the Medical Center, and James Allen, PhD, professor of computer science, worked together to develop an interactive text messaging system to help teens manage their asthma.

They shared their research, which was recently published in the Journal of Patient Preference and Adherence, at an April seminar in Helen Wood Hall Auditorium.


Asthma affects approximately 1 in 10 children and teenagers, making it the most common chronic condition experienced by youths in the United States.


James Allen, Ph.D.

Additionally, research indicates that asthma flare-ups can often be prevented through early detection and management of symptoms and consistent use of preventive medication.

Text reminders have been used successfully to increase medication use and create better outcomes in previous adult studies, but a texting program has not been used for broader purposes, such as for symptom monitoring or promoting a partnership between parents and teens, said Rhee.

So she worked with Allen to develop a texting system — called the Mobile Phone-Based Asthma Self-Management Aid for Adolescents (mASMAA) — that could ask the teens a series of six open-ended questions and accurately interpret the responses.

For example, mASMAA could text a teen the question: “Did you take your asthma medication today?”  Though ostensibly a “yes” or “no” question, mASMAA was capable of responding to a number of different return texts.

“Let’s say in this case, the patient says ‘Not yet,’” said Allen.  “The system then does two things.  First, it texts back ‘Let me know when you do,’ and then it sets a new alarm to ask again at 9 a.m.  If 8 a.m. rolls around and the patient reports that they’ve taken the asthma med, it logs that, says ‘Thanks for letting me know,’ and overrides the alarm.”

The system was also programmed to identify a handful of words which it could record as symptoms and dozens more that it identified as medications.  It also understood text lingo, such as “l8r” and “thx.”

Only when mASMAA received a text that indicated patient discomfort — or a text that was overly complicated — would the system alert a human coordinator, who could seamlessly take over the text conversation.  And once mASMAA compiled its list of information for the day, it would send an email to the teen’s parents, summarizing information related to asthma (e.g., symptoms, activity levels, use of controller and controller meds) the teen had reported throughout the day.

So while a teen might give a dismissive “I’m fine,” when asked about their asthma, parents learned that in reality, their teen might actually have experienced some symptoms throughout the day which they sent and received texts about.  With the extra information, the parents could help to manage their teens’ asthma more effectively.

“Teens want to take care of everything themselves, and asthma is no different,” said Rhee.  “But the evidence suggests that parental involvement in care continues to be beneficial in reducing asthma-related incidents.”

Future improvements

After a group of teen patients and their parents used mASMAA in a two-week trial, the research team received a lot of positive feedback.  Teens and parents both felt they had a greater sense of control over their asthma, and parents liked the daily reports so much that they asked if the system could start sending it to their teen’s pediatrician, as well.

With such strong user buy-in, a broad-scale implementation of a system such as mASMAA could lead to better patient outcomes and tremendous savings on preventable emergency room visits.

But a teen’s willingness to actually send texts back to the system is vital in making sure that mASMAA actually augments successful asthma management.  So the research team also paid close attention to the suggestions they received in a post-study focus group.

Over the two week trial, teens responded to the six daily questions between 81 and 97 percent of the time, which Rhee said was a very good response rate.  But in the focus group, the teens said that six daily questions was too many, and suggested that fewer questions would lead to even better response rates.

They also said that flexible timing on the texts would make for a more user-friendly experience.  A 6 a.m. text makes sense on a school day, but on the weekend, that text was always waking them up.

Researchers also realized that they could continue to work to improve mASMAA’s vocabulary.

“Those kinds of features, we’ll incorporate in our future improvements,” said Rhee.

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