Digital technologies for monitoring and improving treatment adherence in children and adolescents with asthma: A scoping review of randomised controlled trials

Abstract Background Inadequate paediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to help monitor and support treatment adherence for children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research around these technologies and how they are being integrated into existing healthcare services and care pathways. Objective The purpose of this scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. Methods The review was structured according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, EMBASE, and PsycINFO) were systematically searched for studies published in English from 2014 on. One reviewer screened references, selected studies for inclusion based on the eligibility criteria, and extracted the data, which were synthesised in a descriptive analysis. Results A wide variety in study characteristics - including the number and age of participants, study duration, and type of digital intervention - was identified. There was mixed evidence for the effectiveness of the interventions; 6 of the 9 studies that evaluated treatment adherence found improvements, but the evidence was inconsistent for asthma control (4/9 found no evidence of effectiveness, and only one found significant evidence) and health outcome variables (4/7 found no evidence of effectiveness). The 5 studies that examined patient perceptions and assessments of acceptability and usability had generally positive findings. Conclusions Despite the range of different digital interventions being developed to support the monitoring and treatment adherence of children and adolescents with asthma, there is limited evidence to suggest that they achieve their range of intended outcomes. Stronger evidence of their effectiveness at achieving their specific aims is needed, as this will support decisions and research about their cost-effectiveness and how these technologies can best integrate with existing clinical care pathways. This research is necessary to determine which interventions are worth supporting and adopting in the clinical care pathways.