Augmented Reality to Enhance Educational Resources to Improve Inhaler Technique for Young People with Asthma

Abstract

In Australia, 90% of people with asthma are not using their inhalers correctly, yet inhaled medications (inhalers) are first-line pharmacotherapeutic treatment, targeting symptom control and airway inflammation. Incorrect inhaler technique contributes to the 80% of avoidable asthma hospitalisations in Australia, where almost half occur in children. This is of particular concern given asthma is the leading cause of disease burden for youth aged 5- 14 years. Therefore, novel and technology-enhanced interventions to improve asthma management are being called for by experts in the field and the asthma community. One such technology is augmented reality, which utilises mobile devices to create an immersive experience, and may provide a solution for effective asthma inhaler technique education in young people. However, no studies to date have developed an augmented reality mechanism to deliver asthma inhaler technique education in young people with asthma. The objective of this thesis is to address these issues by creating a novel technologyenabled intervention, that will provide a foundation for a sustainable asthma inhaler technique model for young people. This thesis will show that augmented reality is perceived to be a useful tool for education delivery by asthma stakeholders and healthcare professionals (Chapter 5). To inform the setting for the evaluation of the augmented reality-enabled intervention, a Cochrane systematic review has been undertaken (Chapter 6). Current literature on homebased asthma educational interventions was synthesised. This showed no significant difference in health outcomes when education was delivered in the home compared to standard care. Based on results from Chapter 6, the hospital setting was chosen for evaluation of the ARenhanced resource. Mixed-method investigation has been undertaken to determine perceived barriers and facilitators of asthma education delivery amongst healthcare professionals, asthmatic children and their caregivers within the hospital (Chapter 7). Time pressures and uncertainty of healthcare professional roles in delivering education have been identified as barriers, whilst the use of technology-based interventions have been perceived as a facilitator, supporting the development of an augmented reality-enhanced educational intervention. Given the novelty of augmented reality, the slow adoption rate of healthcare professionals to digital interventions, and the importance of end user feedback on successful uptake, this thesis describes the use of an iterative co-design process (Chapter 8). Qualitative and quantitative investigation were also performed for the developed augmented reality intervention in Chapters 8 and 9. Children with asthma, their caregivers and healthcare professionals identified the intervention to have good acceptability and usability. The research performed for this thesis enabled a novel augmented reality technologyenabled prototype intervention to be developed for children for the delivery of asthma inhaler education. This is now being incorporated into a comprehensive asthma model of care which combines multiple technology-enhanced asthma education and selfmanagement tools into one package to test clinical effectiveness in a hospital environment. Results from this thesis including the co-design process, design outcomes and qualitative investigation, produce new evidence to inform development and delivery of technologyenabled asthma inhaler technique education interventions, more likely to be capable of improving inhaler technique, reducing the burden of asthma on Australians.