Asthma UK Centre for Applied Research

Study shows electronic reminders and financial incentives are acceptable to adolescents with asthma

Participants stated that the intervention helped them remember to take their medication, and increased their motivation. A pilot randomised control trial is required to understand the effect on adherence.

Results from a feasibility study led by members of the Asthma UK Centre for Applied Research have shown that electronic reminders and financial rewards to improve adherence to inhaled asthma treatment in young people are feasible and acceptable.

The study, published in the BMJ Open, describes how adolescents with low adherence to asthma medications found that short-term electronic reminders and financial incentives helped them remember, and also increased their motivation, to take their inhaler medication.

Asthma is the most common chronic disease for young people in the UK. When people with asthma adhere to their inhaled corticosteroid (ICS) medication, the chances of having an asthma attack reduce significantly. Adherence to ICS in adolescents in the UK ranges between 25% and 35% of the optimum rate.

Methods of increasing adherence to ICS in adolescents include electronic reminders and financial incentives. This study was the first in the UK to combine electronic reminders and financial incentives as an intervention in adolescents with asthma.

The Study

The study recruited 10 participants between the ages of 11 and 18 with diagnosed asthma who attend asthma clinics in hospital. All participants had been identified as having poor adherence to ICS over the previous year.

The intervention lasted for 24 weeks and consisted of reminders for ICS inhalation using a mobile app, and 8 weeks of incentive payments in the form of gift cards between weeks 8 and 15. The incentive value was capped at £2 per day, for a maximum total amount of £112. Between weeks 16 and 24, participants continued to receive reminders to verify the sustainability of the effects of the incentives.

In 4 asthma clinic visits over the course of the 24 weeks, participants completed an Asthma Control Test score, FeNO (fractional exhaled nitric oxide), spirometry (first second forced expired volume), demographics, asthma history, Brief Illness Perception Questionnaire (B-IPQ), and Beliefs about Medicines Questionnaire (BMQ). In the final visit, participants took part in a semistructured exit interview.


The study showed that the reminders and incentives were acceptable to adolescents. Findings from the questionnaires and exit interviews suggested that the incentives increased motivation for adolescents to take inhalers. This means that the intervention has the potential to improve ICS adherence in young people.

A major obstacle in the study was the technical difficulties with the smartinhaler and the app. Participants found this frustrating and stated that the study would have been more effective if the app system had worked correctly throughout the study.

Future studies

Although this study has shown that electronic reminders and financial incentives are acceptable for adolescents with asthma, further research in the form of a randomised control trial is required to understand the effect on adherence to ICS.

This study forms the background to a PhD study which is being carried by Centre PhD Student Representative, Jasmine Hine. Her PhD includes the randomised control trial that this study recommends.

Dr Anna De Simoni, Centre member and Co-Lead for Patient and Public Involvement, who led this publication, says that despite the technological difficulties the study faced, this could be a very important step for ICS adherence in adolescents.

Our data show that a reminders and incentive intervention to aid adherence to asthma preventer inhalers is acceptable to adolescents and their parents. Rewards of around £80 per participant were successfully delivered. We are delighted that Jasmine Hine, one of the Centre PhD students, is taking this project forward with a feasibility trial.

Dr Anna De SimoniCentre Co-Lead for Patient and Public Involvement and lead author on this publication

Read the paper

This publication is available from BMJ Open

Cite as

De Simoni A, Fleming L, Holliday L, et al. Electronic reminders and rewards to improve adherence to inhaled asthma treatment in adolescents: a non-randomised feasibility study in tertiary care. BMJ Open 2021;11:e053268. doi: 10.1136/bmjopen-2021-053268

Related links

Find out more about Jasmine’s PhD