Scanning the marketplace for asthma, anxiety and depression tracking applications

By Rita Sembajwe, Health Informatics Specialist, BreathEasy Project Manager, RTI International.

Read all of the BreathEasy blog posts.

As the BreathEasy project moves along, the time has come for the team to synthesize our mobile phone application findings related to asthma, anxiety and depression in order to compare them against each other and determine a baseline. Doing this allows us to improve or advance the baseline, instead of duplicating what already exists.

Both the Android and iPhone marketplaces already host some progressive applications. We are reviewing a handful of them and in the process acknowledging things like: user ratings; differences and similarities in technical and scientific features; user friendly architecture; and their target audience.

The asthma applications range from: applications that track peaklfow readings with the help of a graph; electronic asthma journals that track an individual’s asthma symptoms and medication; and applications that do a combination of both. A majority of the depression applications use a set of questions or a depression scale, e.g. HDRS17, built-in to detect and track depression symptoms.  All of the anxiety tracking applications in our selection were a combination of depression, or asthma tracking applications. 

In their own way, all the applications promote innovate ways to track and control conditions, but so far the Asthma Journal is our favorite when it comes to choosing an application that inspires the BreathEasy application development process. It tracks an individual’s asthma symptoms and medication, and has the ability to automatically share them with clinicians and whoever else via Google Health. A similar application on iPhone, Asthma MD, also tracks and charts asthma symptoms and enables the transfer of data to clinicians.

It is also worth highlighting the asthma and anxiety application, TBDeluxe, developed by Kumquat Portable Apps on Android.  It trains those who need to correct their breathing volume on how to breathe.  It tracks an individual’s breathing and guides inhalation and exhalation allowing the oxygenation of organs and systems and in turn reducing symptoms of allergies, asthma, anxiety, stress, and panic attacks, among others. 

BreathEasy will expand on the baseline of the marketplace by developing an Android based, user friendly application that tracks patient’s symptoms of asthma, anxiety and depression, by capturing relevant observations of daily living (ODLs).  Data collected will then be directly available to clinicians via a web dashboard. The target population of this application will be involved in the design and development of this project, through requirements gathering and testing.  We think our user centered design approach will spell success. To hear more about this application…stay tuned!

Taking the time to focus

By Barbara L. Massoudi, RTI International, BreathEasy Principal Investigator.

The BreathEasy team has spent significant time this past month developing our focus group guides to begin to understand the users’ (both patients’ and clinicians’) needs for the PHR tool.  The guides will help us facilitate the discussion around particular topics that are of interest to our research team. There are so many things we’d like to know about the users’ needs, preferences, opinions, beliefs, etc., that paring down the topics is challenging. Here’s are some of the questions we’re thinking about including, please let me know in the comments if you have some other ideas we’d want to consider as well.

Living with asthma and depression or anxiety
What are the biggest challenges in living with these diseases or conditions? How do they affect your daily life? Does one condition seem to outweigh the other? Do these conditions make the other worse?

How easy or difficult is it to talk with your doctor or nurse about your symptoms? Do you keep notes about your health condition or do you just try to remember? How long is it usually between visits to the doctor? Do you find that you have trouble answering questions when it’s been a long time between visits?

How would you feel about a personal health record tool to help you with your conditions? What should it be able to do? How would you use it? What do you think it would be important for your doctor to know about your symptoms and health behaviors, including your personal triggers (read ODLs)? Do you think it would be easy or difficult to keep track of these things?

The BreathEasy smart phone app
Do you use a cell phone? Is your cell phone a smart phone? Do you use apps? What do you like about your favorite apps? Does your phone have a virtual keyboard? Do you find it easy to use or would you prefer to use a physical keyboard?

What would you think about using a free smart phone app to collect and record your symptoms and health behaviors? What problems could you see with using a smart phone app this way? Would you report symptoms as they occurred, or at the end of the day?

Communicating with the doctors and nurses

How would you feel about your healthcare providers being able to see what you record between appointments? How would you feel about discussing the symptoms and health behaviors you recorded with your healthcare provider?  How do you think they would react to this type of system?

What’s next?
Once we hold the focus groups and gather the users’ inputs, we’ll being developing the BreathEasy tool. A subset of our focus group participants will then return in the fall to evaluate the prototype through some usability testing. More on that to come…

BreathEasy - A PHR for Adults with Asthma and Depression or Anxiety

This post is the first in a series that will introduce you to our five grantee teams.

By Barbara L. Massoudi, RTI International, BreathEasy Principal Investigator.

Asthma, depression and anxiety
The link between asthma, depression and anxiety has stymied medical researchers for some time. Despite several studies, it’s really unclear which comes first. The mechanism for the interaction between these two conditions is also a mystery – is it behavioral, environmental, or biological? No one really knows.

Managing these conditions
What we do know is that for people with asthma, managing their condition on a daily basis can be challenging. There are several different types of medications that can be taken and avoiding triggers is an important thing to do as well. Triggers are usually things that we all commonly encounter on a daily basis such as animal dander, pollen, smoke, cold air, even physical activity. Add to all this a condition like depression or anxiety that typically makes people less energetic and less likely to be able to do things to care for themselves. The interaction of the two conditions can lead to a vicious cycle, affecting the quality of life for patients.

The BreathEasy project
This difficulty in self-management and the impact on quality of life is exactly why we decided to tackle this complicated set of conditions through our project. Researchers at RTI International, a non-profit research organization and the Virginia Commonwealth University Department of Family Medicine have teamed up to develop a PHR application to assist people with asthma and depression or anxiety. To develop the tool, we’ll work with about 35 adult patients with asthma and depression or anxiety, recruited from the patient populations served by two primary care clinics in Richmond, VA – the Nelson Clinic and the Hayes E. Willis Health Center. The PHR tool will help these patients track observations of daily living (ODLs) related to their conditions. ODLs can be things that you do everyday – such as taking a medication, or things that you feel – like shortness of breath or a sad mood, as well as objective measures of lung function like peak flows. The importance of capturing the ODLs is that they could hold the key to sorting out an individual’s personal experience with triggers, meds, and symptoms, but they don’t occur in the doctor’s office where they can easily be observed. These are things that occur out in the world, in the course of everyday life, and generally speaking, people aren’t very good at recalling things they do, even on a daily basis. The PHR tool will offer a way to capture and display this information in a way that will be informative to the patients and hopefully, clinically relevant to their health care providers.

The project team
As the principal investigator, I’m working with co-PI, Dr. Steve Rothemich from VCU as well as Dr. Alex Krist, another physician in the Department of Family Medicine. The RTI team consists of Bill Savage who will develop the patient application for the Android-based phone, Mike Zmuda, who will build the clinician dashboard, Sarah Cook, who will conduct focus groups and do usability testing with patients and clinicians to learn what features and tools they’d like the application to have, Rita Sembajwe, who will keep me on track with her project management skills, and develop a newsletter for patients, and Lucia Rojas-Smith, who will design an evaluation to measure the impact of the tool on patients, clinicians, quality of care, patient-clinician communications, etc.

We hope you'll visit our webpage for BreathEasy updates and follow our progress through the blog!