title: Parent and Clinician Preferences for an Asthma App to Promote Adolescent Self-Management: A Formative Study.
abstract: BACKGROUND
  Most youth asthma apps are not designed with parent and clinician use in mind, and rarely is the app development process informed by parent or clinician input.
  
  
  OBJECTIVE
  This study was conducted to generate formative data on the use, attitudes, and preferences for asthma mHealth app features among parents and clinicians, the important stakeholders who support adolescents with asthma and promote adolescent self-management skills.
  
  
  METHODS
  We conducted a mixed-methods study from 2013 to 2014 employing a user-centered design philosophy to acquire feedback from a convenience sample of 20 parents and 6 clinicians. Participants were given an iPod Touch and asked to evaluate 10 features on 2 existing asthma apps. Participant experiences using the apps were collected from questionnaires and a thematic analysis of audio-recorded and transcribed (verbatim) interviews using MAXQDA. Descriptive statistics were calculated to characterize the study sample and app feature feedback. Independent samples t tests were performed to compare parent and clinician ratings of app feature usefulness (ratings: 1=not at all useful to 5=very useful).
  
  
  RESULTS
  All parents were female (n=20), 45% were black, 20% had an income ≥US $50,000, and 45% had a bachelor's degree or higher education. The clinician sample included 2 nurses and 4 physicians with a mean practice time of 13 years. Three main themes provided an understanding of how participants perceived their roles and use of asthma app features to support adolescent asthma self-management: monitoring and supervision, education, and communication/information sharing. Parents rated the doctor report feature highest, and clinicians rated the doctor appointment reminder highest of all evaluated app features on usefulness. The peak flow monitoring feature was the lowest ranked feature by both parents and clinicians. Parents reported higher usefulness for the doctor report (t(10)=2.7, P<.02), diary (t(10)=2.7, P<.03), and self-check quiz (t(14)=2.5, P<.02) features than clinicians. Specific participant suggestions for app enhancements (eg, a tutorial showing correct inhaler use, refill reminders, pop-up messages tied to a medication log, evidence-based management steps) were also provided.
  
  
  CONCLUSIONS
  Parent and clinician evaluations and recommendations can play an important role in the development of an asthma app designed to help support youth asthma management. Two-way asthma care communication between families and clinicians and components involving families and clinicians that support adolescent self-management should be incorporated into adolescent asthma apps.
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Lorie L
authors.identifier: http://orcid.org/0000-0002-0332-0902
authors.initials: LL
authors.lastname: Geryk
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Courtney A
authors.identifier: http://orcid.org/0000-0001-8284-6285
authors.initials: CA
authors.lastname: Roberts
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Adam J
authors.identifier: http://orcid.org/0000-0001-6988-3882
authors.initials: AJ
authors.lastname: Sage
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Tamera
authors.identifier: http://orcid.org/0000-0003-2845-3880
authors.initials: T
authors.lastname: Coyne-Beasley
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Betsy L
authors.identifier: http://orcid.org/0000-0002-8861-6955
authors.initials: BL
authors.lastname: Sleath
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Delesha M
authors.identifier: http://orcid.org/0000-0003-2025-8140
authors.initials: DM
authors.lastname: Carpenter
keywords: adolescents; asthma; clinicians; mHealth; mobile apps; parents; self-management; social support