eHealth only interventions and blended interventions to support self-management in adolescents with asthma: A systematic review

Self-management is important in asthma control. Self-management in adolescents is complicated by physical and psychological developmental transitions, which may result in undertreated, potentially life-threatening asthma. It is unclear which interventions fit adolescents’ needs and improve asthma-related outcomes. This systematic review therefore aimed to identify eHealth interventions that effectively support self-management skills in adolescents with asthma and evaluate the underlying psychological theory. PubMed, Embase, Web of Science, Cochrane Library and PsycINFO were used. Quality of articles was assessed with validated checklists (i.e., STROBE and CONSORT). eHealth only and blended self-management interventions were reported, including underlying psychological theory (if any), features, usability and effects on outcomes (i.e., self-management, knowledge, self-efficacy, asthma control, quality of life, pulmonary function, medication adherence and healthcare visits). Adolescents’ opinions about eHealth and needs for features were reviewed. 25 empirical (quantitative and qualitative) articles were included, representing nineteen eHealth interventions of which four were blended (i.e. combining eHealth and face-to-face contact) and seven were theory-based. Adolescents found the applications and websites easy to use and were positive about eHealth. The studies showed positive effects of the interventions or no differences on self-management, knowledge, self-efficacy, asthma control, quality of life, pulmonary function, medication adherence and healthcare visits. No publications were found that showed negative results of eHealth programmes. Adolescents were positive about self-monitoring, reminder functions and the possibility to share information with others. Adolescents’ needs for future applications included asthma education, gamification and customisation. Given unclarity about operationalizations of underlying theories and small sample sized in blended care interventions, respectively, this review could not assess whether a theoretical basis or blended mode of delivery was related to effectiveness. eHealth interventions seem safe and outcomes are promising, with several studies showing positive effects on asthma control, quality of life and medication adherence, no adverse outcomes were reported. Results suggest that eHealth interventions may be further improved by increasingly tailoring them to adolescents’ needs, such as self-monitoring, reminder functions and the possibility to share information with others. Therefore, physicians can consider using eHealth in daily practice in this patient group, as stand-alone intervention or as blended care.