Background: Asthma is the most common chronic childhood illness and is a leading cause of emergency department visits in the United States. Obesity increases the risk of poor health outcomes, reduced quality of life, and increased health care expenditures among youth with asthma. Weight loss is crucial for improving asthma outcomes in children with obesity. Our study team developed the Childhood Health and Asthma Management Program (CHAMP), a 16-session behavioral family lifestyle intervention (BFI) for school-age children with asthma and obesity and evaluated CHAMP in a randomized controlled trial compared with attention control. There were medium effect sizes favoring CHAMP for changes in body mass index z-scores, asthma control, and lung function among completers (ie, those who attended ≥9 of 16 sessions). Despite high rates of satisfaction reported by families, attendance and trial attrition were suboptimal, which raised concerns regarding the feasibility of CHAMP. Qualitative feedback from participants indicated 3 areas for refinement: (1) a less burdensome intervention modality, (2) a more individually tailored intervention experience, and (3) that interventionists can better answer health-related questions. Objective: We propose to improve upon our pilot intervention by developing the Mobile Childhood Health and Asthma Management Program (mCHAMP), a nurse-delivered BFI, delivered to individual families, and supported by a mobile health (mHealth) app. This study aims to (1) identify structural components of mCHAMP and (2) develop and test the usability of our mCHAMP app. Methods: Participants will be recruited from an outpatient pediatric pulmonary clinic. We will identify the structural components of mCHAMP by conducting a needs assessment with parents of children with asthma and obesity. Subsequently, we will develop and test our mCHAMP app using an iterative process that includes usability testing with target users and pediatric nurses. Results: This study was funded in 2018; 13 parents of children with asthma and obesity participated in the needs assessment. Preliminary themes from focus groups and individual meetings included barriers to engaging in health-promoting behaviors, perceived relationships between asthma and obesity, facilitators to behavior change, and intervention preferences. Participatory design sessions and usability testing are expected to conclude in late 2019. Conclusions: Outcomes from this study are expected to include an mHealth app designed with direct participation from the target audience and usability data from stakeholders as well as potential end users. International Registered Report Identifier (IRRID): DERR1-10.2196/13549
Background: More than 6 million children in the United States have asthma, and more than 20% are clinically obese. Youth with asthma and obesity are susceptible to poor health outcomes, including greater asthma symptom severity and hospitalizations, reduced physical activity, and poorer quality of life. Mobile health technologies can increase access to chronic disease self-management interventions, and family members can be powerful influencers given their substantial control over a child’s behavior and home environment. Objective: The Mobile Childhood Asthma Management Program (mCHAMP) app is based on the in-person Childhood Asthma Management Program (CHAMP) behavioral family intervention pilot trial of school-aged children with asthma and obesity. In this study, we translated the CHAMP content into digital content and conducted summative testing to measure the usability, learnability, and efficiency of the mCHAMP app. Methods: We applied a sequential mixed methods approach. The mCHAMP app targeted adult caregivers of children living with asthma and obesity aged 6 to 12 years. A consumer-centered approach was used to guide the identification of user requirements and conduct of summative usability testing. While the mCHAMP app is primarily caregiver facing, it is intended to connect caregivers with registered nurse (RN) interventionists. Therefore, we sought feedback from RNs as key stakeholders. Results: Caregivers (n=10) were female (n=10, 100%) and mostly African American (n=8, 80%), and half (n=5, 50%) had an annual household income of <US $25,000; most of their children (n=6, 60%) were in the 99th BMI percentile. Post-Study eHealth Usability Questionnaire scores indicated high overall satisfaction, usefulness, and quality of the mCHAMP app. Most caregivers (n=7, 70%) were able to complete all 15 tasks across the 6 modules with 2 or fewer hints. The average total time to complete all tasks was 17 (SD 3.9; range 11.4-24.1) minutes. Most caregivers (n=7, 70%) wanted information in static form but also preferred alternatives (eg, audio or video) to support flexibility with consuming the content. Caregivers expressed the need for more child-facing content as well as tailored decision support related to diet and exercise. RNs (n=5) strongly endorsed their role and use of the mCHAMP app to promote self-management among caregivers of children with obesity and asthma. They noted the importance of integrating the mCHAMP app into a local electronic health record and existing workflows. Conclusions: Caregivers expressed a desire for an intervention that was easy to use and could integrate into their busy family lives. We met this expectation based on the usability, learnability, and efficiency results of our study. The mCHAMP app has the potential to increase self-management for parents and pediatric patients with asthma with multimorbidity, which could improve patient and health system outcomes. The use of mCHAMP may also enable novel clinical outcome studies based on patient-reported data from the app.