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Games Health J. 2019 Oct;8(5):357-365. doi: 10.1089/g4h.2019.0011. Epub 2019 Jun 3.

Dose Matters: A Smartphone Application to Improve Asthma Control Among Patients at an Urban Pediatric Primary Care Clinic.

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Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.


Objective: As the most common chronic condition of childhood, asthma is a frequent target for family education. However, current educational strategies rarely tailor to learning style or literacy level. Thus, we developed and implemented a smartphone application (app) leveraging gamified features entitled CHANGE Asthma ("Clinic, Home, And on the Go Education for Asthma"). We subsequently assessed its impact on asthma control. Methods: Patients aged 4-11 years with a previously documented childhood asthma control test (C-ACT) score of <20, indicating poor control, were recruited to participate in this randomized control pilot study. The intervention group downloaded CHANGE Asthma; asthma control was assessed at enrollment and at follow-up. The changes in C-ACT score in both groups were compared using analysis of covariance (primary outcome). App usage was monitored for 4 months following download, and the relationship between usage time, and the change in C-ACT score was assessed via linear regression. Results: The control and intervention groups both included 20 caregivers with 75% of participants completing follow-up. Although C-ACT scores among intervention participants significantly improved at follow-up, compared to their own baseline (P = 0.04), the change of C-ACT score did not significantly differ from that of the control group (P = 0.78). Among the intervention participants, there was a positive, dose-dependent relationship between app usage time and positive change in C-ACT score (P = 0.03). Conclusion: Usage of a gamified app was associated with a dose-dependent improvement in asthma control over time, suggesting that further evaluation of apps for asthma education, and perhaps for other chronic conditions, is warranted.


App; Asthma; Games; Parent education; Smartphone


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