Project: Electronic reminders and incentives to improve adherence to inhaled asthma treatment in adolescents
PhD Title: Electronic reminders and incentives to improve adherence to inhaled asthma treatment in adolescents
Funded by: Asthma UK
Supervisors: Dr Louise Fleming, Professor Andy Bush, Dr Anna De Simoni & Professor Chris Griffiths
Based at: Imperial College London
Non-adherence to inhaled asthma treatments is an incredibly important modifiable factor that has been reported to contribute to avoidable asthma-related deaths. Unfortunately, medication adherence is a significant issue within paediatric asthma and is a key challenge that needs to be addressed as it can result in escalated healthcare costs, hospital admissions, exacerbation of symptoms as well as asthma-related mortality.
Although accurate measuring of adherence has always been deemed challenging, electronic monitoring devices (EMDs) are considered the ‘gold standard’ for measuring adherence within asthma. EMDs have also been beneficial and effective as an adherence intervention tool, due to their ability to provide electronic reminders directly to the patient to take their prescribed inhaled dose. However, despite their effectiveness in improving medication adherence, it has also been reported that these improvements wain after time (typically post-intervention even though reminders are still being provided) suggesting they are insufficient on their own to improve and sustain medication adherence.
Financial incentives are widely accepted and effectively used within healthcare to encourage the adoption of healthy behaviours and, more specifically, have been cited to improve medication adherence in some studies for other health conditions.
Therefore, the aim of my PhD is to assess the effectiveness and acceptability of the use of incentives and reminders in the management of asthma in adolescents. It will have 3 main components; 1) systematic review of financial incentives used in healthcare, 2) consolidation of the pilot study that aimed to explore the acceptability of incentives within asthma management and 3) develop randomized controlled trial (RCT) that aims to assess the effectiveness of incentives and reminders within asthma management that compares the use of reminders and incentives with usual care. The primary outcome for the RCT will be adherence and secondary outcomes will include asthma control and cost-effectiveness.
I previously completed a BSc in Sport and Exercise Psychology at the University of Chichester where I developed an interest in health behaviours – particularly the exploration of motivations towards health behaviours - and so followed this by a MSc in Health Psychology at the University of Southampton. Since then, I have found a real interest in understanding the health behaviours and psychosocial underpinnings of chronic conditions as well as patient health and well-being. I have been involved with various projects using both qualitative and quantitative methods that explore this, including the psychological impact of chronic injury, the development of a psychosocial intervention to assist cancer patients after surgery and an evaluation of the health and well-being provisions for NHS staff.
Having also worked within an educational setting, I enjoy research that focuses upon paediatric healthcare. I would love to pursue a career within research but would also like to complete my Health Psychology Stage 2, in order to do some clinical work alongside my research.
Hine J, Lee B, Bush A, et al. Patient financial incentives to improve asthma management: a systematic review. BMJ Open 2023;13:e070761. doi: 10.1136/bmjopen-2022-070761
This work is funded by Asthma UK as part of the Asthma UK Centre for Applied Research.