Background and Rationale: Asthma is the most common chronic illness affecting youth, with prevalence and morbidity being significant among adolescents. School-based and web-based asthma interventions have been shown to be effective with younger children. Yet, few interventions have been developed and tested with high school students, with only one currently deployed online. The efficacy of Asthma Self-Management for Adolescents (ASMA), an in-person evidence-based high school based intervention, has been established; we have also successfully commercialized technology products for youth that are built on 3C's dynamic e-learning platform (DELP). Objective: This Direct to Phase II SBIR project will fully develop and preliminarily validate ASMA 2.0, an empirically-based dynamic e-health intervention to assist adolescents with uncontrolled asthma to learn how to manage their illness and improve their asthma control. We will apply our demonstrated DELP platform to deploy this demonstrated asthma intervention. Building on ASMA's success, ASMA 2.0 will be grounded in social cognitive theory, motivational interviewing, and best practices for user interface design to create a product that can be disseminated to a broad audience of users. We will accomplish three specific aims: (1) to fully develop ASMA 2.0, including eight modules with core instructional topics, tailored sessions, and embedded interactive activities; (2) to conduct a two group randomized pilot trial with 70, 9th - 12th graders with uncontrolled asthma from two NYC public high schools in order to assess the preliminary intervention effects of ASMA 2.0, and to evaluate the feasibility and acceptability of ASMA 2.0; and (3) to finalize and prepare ASMA 2.0 for commercialization based on feedback from adolescents who participated in the pilot test of ASMA 2.0 and stakeholders who treat and/or educate adolescents with asthma or who are likely payers. We will also evaluate the reach, acceptability, feasibility, and sustainability of the ASMA 2.0 product. Hypotheses: Over two months post-intervention, relative to controls, ASMA 2.0 participants will show significantly greater improvement in asthma-related outcomes. We also hypothesize that ratings and software usage indices will demonstrate that ASMA 2.0 is a feasible, usable, and acceptable intervention for use with adolescents. We will also explore evidence of a dose-response in which participants who spend more time engaged with the e- training materials show greater positive change. Significance: ASMA 2.0 will be the first dynamically adaptive, personalized, interactive software product specifically designed for improving management of asthma and asthma control in adolescents with uncontrolled asthma. As detailed in the Commercialization Plan, ASMA 2.0 will be a unique commercial offering within a large potential market, with revenue being generated through sales to schools, clinics, emergency departments, health insurance companies, and professional health organizations (e.g., local ALA chapters, asthma coalitions).
Asthma is the most common chronic illness in youth. The total economic impact of asthma in school-aged youth is estimated to be nearly $2 billion and the disability-adjusted life years lost estimate due to asthma is 15 million per year, on par with diabetes. Asthma has greater prevalence and morbidity among adolescents than young children, and asthma-related activity limitations increase with age. Yet, adolescents are less likely to receive regular medical care for their asthma and few interventions have been empirically established for use with adolescents. The proposed Direct-to-Phase II SBIR will address this critical need by developing and testing ASMA 2.0, the first e-health intervention product for adolescents with uncontrolled asthma which leverages intelligent games, adaptive interactive exercises, and dynamically generated personalized feedback within a dynamic e-learning platform to reach the broadest number of youth possible.
