K4Health
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This Digital Health Resource Library houses three legacy collections previously maintained by the Knowledge for Health (K4Health) Project. K4Health’s work was made possible by the support of the American People through the United States Agency for International Development (USAID) . K4Health was supported from 2008-2019 by USAID's Office of Population and Reproductive Health, Bureau for Global Health, under cooperative agreements with the Johns Hopkins University. K4Health was implemented by the Johns Hopkins Center for Communication Programs (CCP) in collaboration with FHI 360, Management Sciences for Health (MSH), and IntraHealth International. The K4Health Project ended in September 2019.
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Browsing K4Health by Subject "Asthma"
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- ItemAssessing adolescent asthma symptoms and adherence using mobile phones.(2013-07-18) Mulvaney, Shelagh A; Ho, Yun-Xian; Cala, Cather M; Chen, Qingxia; Nian, Hui; Patterson, Barron L; Johnson, Kevin BBACKGROUND Self report is the most common method of measuring medication adherence but is influenced by recall error and response bias and it typically does not provide insight into the causes of poor adherence Ecological momentary assessment EMA of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving OBJECTIVE To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making METHODS We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system Adolescents aged 12 18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center A survey including barriers to mobile phone use the Illness Management Survey and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month The Asthma Control Test ACT was administered at 2 study time points baseline and 1 month after baseline RESULTS The sample consisted of 53 adolescents who were primarily African American 34 53 64 and female 31 53 58 with incomes US 40K year or lower 29 53 55 The majority of adolescents 37 53 70 reported that they carried their phones with them everywhere but only 47 25 53 were able to use their mobile phone at school Adolescents responded to an average of 20 1 SD 8 1 of the 30 daily calls received 67 Response frequency declined during the last week of the month b 0 29 PUnder 001 and was related to EMA reported levels of rescue inhaler adherence r 0 33 P 035 Using EMA adolescents reported an average of 0 63 SD 1 2 asthma symptoms per day and used a rescue inhaler an average of 70 of the time SD 35 when they experienced symptoms About half 26 49 53 of the instances of nonadherence took place in the presence of friends The EMA measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT r 0 33 P 034 CONCLUSIONS Mobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents The EMA method was consistent with the ACT a widely established measure of asthma control and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web based support system
- ItemBreath sounds, asthma, and the mobile phone.(2001-10-30) Anderson, K; Qiu, Y; Whittaker, A R; Lucas, MThe sounds generated by breathing in asthma are widely accepted as an indicator of disease activity We have investigated the use of a mobile phone and electronic signal transfer by e mail and voice mail to study tracheal breath sounds in individuals with normal lung function and patients with chronic or exercise induced asthma Spectrograms from patients with active asthma and impaired lung function were significantly different from people without asthma pUnder0 0001 Our results suggest that mobile phone recordings clearly discriminate tracheal breath sounds in asthma and could be a non invasive method of monitoring airway diseases
- ItemBuilding patient relationships: a smartphone application supporting communication between teenagers with asthma and the RN care coordinator.(2013-06-24) Haze, Kimberly A; Lynaugh, JillianSmartphone applications used in healthcare are emerging as an adjunct therapy to assist patients in self management Often smartphone technology is not integrated into healthcare delivery and does not build the nurse patient relationship an essential mechanism to guide the patient toward health In a pilot study using smartphones with teenagers with asthma the application provided a method not only to share health information at the point of living including health assessments personalized health plans and disease information but also to allow text messaging communication between the teenager and his her RN care coordinator Twenty five teenagers piloted the smartphone application and provided feedback about its use Eighty five percent of the teenagers responding to the end of pilot semistructured interview indicated a positive change in the nurse patient relationship Teenagers perceived that they could ask more questions along with having improved access and quicker response times The RN care coordinators perceived improved ability to contact teenagers and improved accuracy of assessment data Although the pilot had several limitations it demonstrates that smartphone technology and text messaging can further the nurse patient relationship For this to occur nurses need to become involved in the development and integration of technology to focus applications on innovative ways to enhance communication in patient care
- ItemChallenges of a mobile application for asthma and allergic rhinitis patient enablement-interface and synchronization.(2013-01-15) Burnay, Eduardo; Cruz-Correia, Ricardo; Jacinto, Tiago; Sousa, Ana Sá; Fonseca, JoãoBACKGROUND Asthma and allergic rhinitis ARA are common inflammatory diseases of the airways Enhancement of a patient s participation on clinical decisions is related to better results in control of diseases To control ARA patients should monitor their symptoms avoid triggers and follow their treatment plan This study described the challenges of developing a mobile application called m Carat that records the main events related to ARA MATERIALS AND METHODS The mobile application m Carat was developed for Android Google Mountain View CA and iPhone Apple San Jose CA smartphones It was developed using PhoneGap which allows the development of applications for several mobile operating systems To generate the user interface jQuery Mobile HTML Javascript and CSS were used Despite the use of mobile development frameworks some input and output elements had to be improved To evaluate the interface a pilot study was performed with eight users who performed 10 different tasks in the application To synchronize m Carat with an online database an algorithm was developed from scratch This feature represents a major challenge because all the changes must be reflected in all devices RESULTS Currently m Carat is a mobile application where ARA patients fill out a questionnaire to assess the degree of control of ARA and record their exacerbations triggers symptoms medications lung function tests and visits to the doctor or the hospital They also can receive information and news about ARA define medication and tasks notifications and synchronize all records at caratnetwork org with an online database The evaluation showed some of the adopted solutions to improve interface usability did not work as expected Of the 80 total tasks tested the users had no difficulty in 37 46 Most of the problems observed were easily solved CONCLUSIONS m Carat is a mobile application for ARA that may contribute to patient enablement The development of m Carat suggests that mobile applications may introduce specific challenges that need new solutions
- ItemA daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study.(2010-02-03) Strandbygaard, Ulla; Thomsen, Simon Francis; Backer, VibekeBACKGROUND Poor adherence to asthma treatment is a well recognised challenge and is associated with increased morbidity mortality and consumption of health care resources This study examined the impact of receiving a daily text message reminder on one s cell phone on adherence to asthma treatment METHODS A total of 26 subjects aged 18 45 years with a clinical history of asthma and a positive methacholine challenge test PD 20 Underor 4micromol were randomised to receive or to not receive a daily short message service SMS reminder on their cell phone to take their anti asthmatic medication Inhaled corticosteroids to last for eight weeks and a prescription for four additional weeks were given to the subjects The primary outcome was adherence to asthma treatment Secondary outcomes were reimbursement of asthma medication and change in exhaled nitric oxide levels lung function and airway responsiveness RESULTS The absolute difference in mean adherence rate between the two groups after 12 weeks was 17 8 95 CI 3 2 32 3 p 0 019 No significant differences were observed between the two randomisation groups for the secondary outcomes CONCLUSION Daily text message reminders are already after a short period of observation associated with increased adherence to anti asthmatic medication
- ItemFeasibility of mobile phone-based management of chronic illness.(2011-02-24) Smith, Joshua C; Schatz, Bruce RAccording to the CDC chronic conditions such as heart disease cancer and diabetes cause 75 of healthcare spending in the United States and contribute to nearly seven in ten American deaths However despite the prevalence and high cost of chronic disease they are also among the most preventable of health problems1 How can we use technology to improve self care reduce costs and lessen the burden on medical professionals Devices to help manage chronic illness have been marketed for years but are these specialized devices really necessary In this paper the authors identify the aspects of the major chronic illnesses that most need to be controlled and monitored in the US today and explore the feasibility of using current mobile phone technology to improve the management of chronic illness Here we show that even the average mobile phone is capable of improving the management of all relevant health features in some way
- ItemA guideline implementation system using handheld computers for office management of asthma: effects on adherence and patient outcomes.(2000-05-12) Shiffman, R N; Freudigman, M d; Brandt, C A; Liaw, Y; Navedo, D DTo evaluate effects on the process and outcomes of care brought about by use of a handheld computer based system that implements the American Academy of Pediatrics guideline on office management of asthma exacerbations
- ItemInteractive asthma learning system utilizing a mobile phone platform.(2008-11-12) Wood, Jeffrey; Yablochnikov, Ilya; Finkelstein, JosephWe developed an interactive patient learning system for use on mobile phones to inform an asthma patient about this chronic condition and enforce knowledge retention by questioning the user The system uses a mobile phone s Internet connection to retrieve information from a database and download recorded audio files corresponding to asthma information screens The mobile application was successfully developed implemented and tested on the Motorola i730 mobile phone with Nextel as a service provider
- ItemA low-cost mobile adaptive tracking system for chronic pulmonary patients in home environment.(2013-01-15) Işik, Ali Hakan; Güler, Inan; Sener, Melahat UzelOBJECTIVE The main objective of this study is presenting a real time mobile adaptive tracking system for patients diagnosed with diseases such as asthma or chronic obstructive pulmonary disease and application results at home The main role of the system is to support and track chronic pulmonary patients in real time who are comfortable in their home environment It is not intended to replace the doctor regular treatment and diagnosis MATERIALS AND METHODS In this study the Java 2 micro edition based system is integrated with portable spirometry smartphone extensible markup language based Web services Web server and Web pages for visualizing pulmonary function test results The Bluetooth Bluetooth SIG Kirkland WA virtual serial port protocol is used to obtain the test results from spirometry General packet radio service wireless local area network or third generation based wireless networks are used to send the test results from a smartphone to the remote database The system provides real time classification of test results with the back propagation artificial neural network algorithm on a mobile smartphone It also provides the generation of appropriate short message service based notification and sending of all data to the Web server In this study the test results of 486 patients obtained from Atat rk Chest Diseases and Thoracic Surgery Training and Research Hospital in Ankara Turkey are used as the training and test set in the algorithm RESULTS The algorithm has 98 7 accuracy 97 83 specificity 97 63 sensitivity and 0 946 correlation values The results show that the system is cheap 900 Euros and reliable CONCLUSIONS The developed real time system provides improvement in classification accuracy and facilitates tracking of chronic pulmonary patients
- ItemMicrofluidic CD4+ and CD8+ T lymphocyte counters for point-of-care HIV diagnostics using whole blood.(2013-12-05) Watkins, Nicholas N; Hassan, Umer; Damhorst, Gregory; Ni, Hengkan; Vaid, Awais; Rodriguez, William; Bashir, RashidRoughly 33 million people worldwide are infected with HIV disease burden is highest in resource limited settings One important diagnostic in HIV disease management is the absolute count of lymphocytes expressing the CD4 and CD8 receptors The current diagnostic instruments and procedures require expensive equipment and trained technicians In response we have developed microfluidic biochips that count CD4 and CD8 lymphocytes in whole blood samples without the need for off chip sample preparation The device is based on differential electrical counting and relies on five on chip modules that in sequence chemically lyses erythrocytes quenches lysis to preserve leukocytes enumerates cells electrically depletes the target cells CD4 or CD8 with antibodies and enumerates the remaining cells electrically We demonstrate application of this chip using blood from healthy and HIV infected subjects Erythrocyte lysis and quenching durations were optimized to create pure leukocyte populations in less than 1 min Target cell depletion was accomplished through shear stress based immunocapture using antibody coated microposts to increase the contact surface area and enhance depletion efficiency With the differential electrical counting method device based CD4 and CD8 T cell counts closely matched control counts obtained from flow cytometry over a dynamic range of 40 to 1000 cells l By providing accurate cell counts in less than 20 min from samples obtained from one drop of whole blood this approach has the potential to be realized as a handheld battery powered instrument that would deliver simple HIV diagnostics to patients anywhere in the world regardless of geography or socioeconomic status
- ItemA mobile phone short message service improves perceived control of asthma: a randomized controlled trial.(2012-07-20) Lv, Yanhua; Zhao, Haijin; Liang, Zhenyu; Dong, Hangming; Liu, Laiyu; Zhang, Dandan; Cai, ShaoxiOBJECTIVE Mobile phone short message service SMS has been suggested as a potentially powerful tool to improve asthma outcomes and it can overcome external barriers such as time and distance to participate education programs We wanted to know whether SMS can help to overcome intrinsic barriers such as perceived control of asthma PCA SUBJECTS AND METHODS One hundred fifty outpatients with asthma were randomly assigned to the control traditional and SMS groups Patients in all groups received verbal education based on the Global Initiative for Asthma and patients in the traditional group received additional individualized asthma action plan for self management with peak expiratory flow monitoring and recording asthma diary while patients in the SMS group received additional daily SMS reminders on their mobile phone The six item PCA Questionnaire PCAQ 6 Standard Asthma Specific Quality of Life AQLQ S spirometry blood and induced sputum cell count follow up compliance rate medicine compliance rate and emergency department ED visits data were collected at the initial visit and at 12 weeks RESULTS In total 71 participants completed the trial for analysis Patients PCAQ 6 score was significantly increased in the SMS and traditional groups pUnder0 001 after 12 weeks and the change of patients PCAQ 6 score in the SMS group was higher than in the traditional group p 0 018 Patients in the SMS group had the highest AQLQ S score and follow up rate after 12 weeks The change in PCAQ 6 score was associated with change in AQLQ S score r 0 442 Patients in all groups had better forced expiratory volume in 1 s FEV1 and fewer ED visits after 12 weeks but no significant differences were found among the three groups in the changes of FEV1 and blood and induced sputum eosinophil counts and neutrophil counts CONCLUSIONS SMS can improve PCA and it has a greater advantage in improving follow up rate and asthma specific quality of life than traditional programs
- ItemMobile phone text messaging can help young people manage asthma.(2002-09-13) Neville, Ron; Greene, Alexandra; McLeod, John; Tracey, Andrew; Tracy, Andrew; Surie, John
- ItemMobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study.(2014-01-28) Rhee, Hyekyun; Allen, James; Mammen, Jennifer; Swift, MaryPURPOSE Adolescents report high asthma related morbidity that can be prevented by adequate self management of the disease Therefore there is a need for a developmentally appropriate strategy to promote effective asthma self management Mobile phone based technology is portable commonly accessible and well received by adolescents The purpose of this study was to develop and evaluate the feasibility and acceptability of a comprehensive mobile phone based asthma self management aid for adolescents mASMAA that was designed to facilitate symptom monitoring treatment adherence and adolescent parent partnership The system used state of the art natural language understanding technology that allowed teens to use unconstrained English in their texts and to self initiate interactions with the system MATERIALS AND METHODS mASMAA was developed based on an existing natural dialogue system that supports broad coverage of everyday natural conversation in English Fifteen adolescent parent dyads participated in a 2 week trial that involved adolescents daily scheduled and unscheduled interactions with mASMAA and parents responding to daily reports on adolescents asthma condition automatically generated by mASMAA Subsequently four focus groups were conducted to systematically obtain user feedback on the system Frequency data on the daily usage of mASMAA over the 2 week period were tabulated and content analysis was conducted for focus group interview data RESULTS Response rates for daily text messages were 81 97 in adolescents The average number of self initiated messages to mASMAA was 19 per adolescent Symptoms were the most common topic of teen initiated messages Participants concurred that use of mASMAA improved awareness of symptoms and triggers promoted treatment adherence and sense of control and facilitated adolescent parent partnerships CONCLUSION This study demonstrates the utility and user acceptability of mASMAA as a potential asthma self management tool in a selective group of adolescents Further research is needed to replicate the findings in a large group of adolescents from sociodemographically diverse backgrounds to validate the findings
- ItemPatient-clinician mobile communication: analyzing text messaging between adolescents with asthma and nurse case managers.(2015-01-20) Yoo, Woohyun; Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V; Gustafson, David HBACKGROUND With the increasing penetration of digital mobile devices among adolescents mobile texting messaging is emerging as a new channel for patient clinician communication for this population In particular it can promote active communication between healthcare clinicians and adolescents with asthma However little is known about the content of the messages exchanged in medical encounters via mobile text messaging Therefore this study explored the content of text messaging between clinicians and adolescents with asthma MATERIALS AND METHODS We collected a total of 2 953 text messages exchanged between 5 nurse case managers and 131 adolescents with asthma through a personal digital assistant The text messages were coded using a scheme developed by adapting categories from the Roter Interaction Analysis System RESULTS Nurse case managers sent more text messages n 2 639 than adolescents with asthma Most messages sent by nurse case managers were targeted messages n 2 475 directed at all adolescents with asthma whereas there were relatively few tailored messages n 164 that were created personally for an individual adolescent In addition both targeted and tailored messages emphasized task focused behaviors over socioemotional behaviors Likewise text messages n 314 sent by adolescents also emphasized task focused over socioemotional behaviors CONCLUSIONS Mobile texting messaging has the potential to play an important role in patient clinician communication It promotes not only active interaction but also patient centered communication with clinicians In order to achieve this potential healthcare clinicians may need to focus on socioemotional communication as well as task oriented communication
- ItemA PDA-based Network for Telemonitoring Asthma Triggering Gases in the El Paso School Districts of the US - Mexico Border Region.(2007-02-06) Shenoy, Namdev; Nazeran, HomerIn this paper we describe the application of a personal digital assistant PDA or pocket PC as an effective communication device to telemonitor levels of asthma triggering gases collected from a remote location under test to a workstation which has a personal computer PC running on Windows XPAnd 174 as the operating system The BluetoothAnd 174 features of the PDA are explored to transmit data collected by a DirectAnd 8482 Sense Tox toxic gas monitor equipped with five toxic gas probes and one temperature sensor in real time thereby making this telemonitoring system an innovative instrument in monitoring levels of asthma triggering gases in the El Paso border metropolitan region a region in which asthma is highly prevalent especially in children At the workstation or fixed location these readings are displayed using a custom made user friendly graphical user interface GUI developed using software tools like action scripting with MacromediaAnd 174 FlashAnd 8482 The growing advancement in technology and ever diminishing sizes of handheld devices encouraged us to opt for this configuration Moreover the PDA and toxic gas monitor were also chosen for their light weight portability flexibility low cost and data collection and transmission capabilities
- ItemSmartphone and tablet self management apps for asthma.(2013-12-02) Marcano Belisario, José S; Huckvale, Kit; Greenfield, Geva; Car, Josip; Gunn, Laura HBACKGROUND Asthma is one of the most common long term conditions worldwide which places considerable pressure on patients communities and health systems The major international clinical guidelines now recommend the inclusion of self management programmes in the routine management of patients with asthma These programmes have been associated with improved outcomes in patients with asthma However the implementation of self management programmes in clinical practice and their uptake by patients is still poor Recent developments in mobile technology such as smartphone and tablet computer apps could help develop a platform for the delivery of self management interventions that are highly customisable low cost and easily accessible OBJECTIVES To assess the effectiveness cost effectiveness and feasibility of using smartphone and tablet apps to facilitate the self management of individuals with asthma SEARCH METHODS We searched the Cochrane Airways Group Register CAGR the Cochrane Central Register of Controlled Trials CENTRAL MEDLINE EMBASE PsycINFO CINAHL Global Health Library Compendex Inspec Referex IEEEXplore ACM Digital Library CiteSeer x and CAB abstracts via Web of Knowledge We also searched registers of current and ongoing trials and the grey literature We checked the reference lists of all primary studies and review articles for additional references We searched for studies published from 2000 onwards The latest search was run in June 2013 SELECTION CRITERIA We included parallel randomised controlled trials RCTs that compared self management interventions for patients with clinician diagnosed asthma delivered via smartphone apps to self management interventions delivered via traditional methods e g paper based asthma diaries DATA COLLECTION AND ANALYSIS We used standard methods expected by the Cochrane Collaboration Our primary outcomes were symptom scores frequency of healthcare visits due to asthma exacerbations or complications and health related quality of life MAIN RESULTS We included two RCTs with a total of 408 participants We found no cluster RCTs controlled before and after studies or interrupted time series studies that met the inclusion criteria for this systematic review Both RCTs evaluated the effect of a mobile phone based asthma self management intervention on asthma control by comparing it to traditional paper based asthma self management One study allowed participants to keep daily entries of their asthma symptoms asthma medication usage peak flow readings and peak flow variability on their mobile phone from which their level of asthma control was calculated remotely and displayed together with the corresponding asthma self management recommendations In the other study participants recorded the same readings twice daily and they received immediate self management feedback in the form of a three colour traffic light display on their phones Participants falling into the amber zone of their action plan twice or into the red zone once received a phone call from an asthma nurse who enquired about the reasons for their uncontrolled asthma We did not conduct a meta analysis of the data extracted due to the considerable degree of heterogeneity between these studies Instead we adopted a narrative synthesis approach Overall the results were inconclusive and we judged the evidence to have a GRADE rating of low quality because further evidence is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate In addition there was not enough information in one of the included studies to assess the risk of bias for the majority of the domains Although the other included study was methodologically rigorous it was not possible to blind participants or personnel in the study Moreover there are concerns in both studies in relation to attrition bias and other sources of bias One study showed that the use of a smartphone app for the delivery of an asthma self management programme had no statistically significant effect on asthma symptom scores mean difference MD 0 01 95 confidence interval CI 0 23 to 0 25 asthma related quality of life MD of mean scores 0 02 95 CI 0 35 to 0 39 unscheduled visits to the emergency department OR 7 20 95 CI 0 37 to 140 76 or frequency of hospital admissions odds ratio OR 3 07 95 CI 0 32 to 29 83 The other included study found that the use of a smartphone app resulted in higher asthma related quality of life scores at six month follow up MD 5 50 95 CI 1 48 to 9 52 for the physical component score of the SF 12 questionnaire MD 6 00 95 CI 2 51 to 9 49 for the mental component score of the SF 12 questionnaire improved lung function PEFR at four MD 27 80 95 CI 4 51 to 51 09 five MD 31 40 95 CI 8 51 to 54 29 and six months MD 39 20 95 CI 16 58 to 61 82 and reduced visits to the emergency department due to asthma related complications OR 0 20 95 CI 0 04 to 0 99 Both studies failed to find any statistical differences in terms of adherence to the intervention and occurrence of other asthma related complications AUTHORS CONCLUSIONS The current evidence base is not sufficient to advise clinical practitioners policy makers and the general public with regards to the use of smartphone and tablet computer apps for the delivery of asthma self management programmes In order to understand the efficacy of apps as standalone interventions future research should attempt to minimise the differential clinical management of patients between control and intervention groups Those studies evaluating apps as part of complex multicomponent interventions should attempt to tease out the relative contribution of each intervention component Consideration of the theoretical constructs used to inform the development of the intervention would help to achieve this goal Finally researchers should also take into account the role of ancillary components in moderating the observed effects the seasonal nature of asthma and long term adherence to self management practices
- ItemSocial media, text messaging, and email-preferences of asthma patients between 12 and 40 years old.(2011-09-28) Baptist, Alan P; Thompson, Michael; Grossman, Karla Stoermer; Mohammed, Layla; Sy, Annie; Sanders, Georgiana MBACKGROUND Electronic media such as social media Facebook Twitter MySpace email and text messaging could be useful in the management of asthma However patient use and preferences for electronic media in asthma management is currently unknown METHODS A survey was sent to asthma patients between 12 40 years of age The survey collected demographic information use of electronic media interest in using electronic media to receive asthma information and interest in using electronic media to communicate with a health care provider about asthma Free text entries were encouraged RESULTS 145 completed surveys were returned Text messaging email and Facebook were used at least weekly by a majority of respondents 82 77 and 65 respectively Email was clearly the most preferred method to receive asthma information and to communicate with a physician There was some interest in using Facebook or text messaging whereas Myspace and Twitter had minimal interest On logistic regression analysis female and Black or Hispanic participants were more likely to have an interest in the use of electronic media for asthma care Frequent users 1X week of each electronic media type had greater enthusiasm for their incorporation into asthma care Free text entries revealed that many participants felt social media sites were for connecting with friends rather than for health care and privacy concerns were also raised CONCLUSION Electronic media offers a novel way to improve asthma care Email was the most preferred method though text messaging and social media sites like Facebook may be appropriate for certain patients