It’s not easy living with cystic fibrosis (CF). The multitude of medications, therapies and nutritional supplements that children and adolescents with the disease require can be exhausting and overwhelming, leading to high rates of nonadherence, particularly in adolescents. That’s why Gabriela Oates, Ph.D., an assistant professor of pulmonary and sleep medicine in the University of Alabama at Birmingham (UAB) Department of Pediatrics at Children’s of Alabama, is working to create a mobile health application designed to bridge the gap between what is and what should be when it comes to managing the disease.
The application builds on one developed in Sweden, which 65 to 87% of CF families in that country now use. Called Genia, the app is used to track symptoms, activities and aspects of daily care and share them with the clinical team.
In modifying Genia for the U.S., Oates and her team didn’t rely on what they thought it should look like. They turned to the experts, holding five focus groups with adolescents with CF, families of younger children with CF and the clinicians who care for them. The approach is called “health care service coproduction” and its central tenet is getting buy-in from both clinicians and patients. It’s part of the movement away from the paternalistic view of health and medicine in which the doctor alone drives the process.
The focus groups showed differences between what the clinicians wanted the app to do and what the families and patients asked for, something Oates said the team expected. “The clinicians don’t have the lived experience of managing the disease on a daily basis; our patients and families provided that. However, the clinicians told us what’s necessary to make it work in the clinic; capturing just the patient perspective would have led to an app that’s not workable in the clinical setting.”
Among the changes the focus group participants requested and the team implemented were adding a mental health tracker, making other trackers (i.e., nutrition, medication, physical activity) more specific, syncing the app with calendars and customizing the app with avatars, images and colors.
One thing parents wanted that the adolescents didn’t: the ability to see their child’s entries. On this point, the team decided that the account holder gets to determine the privacy setting and each family decides who the account holder is. “This is normal,” said Oates. “Our children are supposed to become independent and take over the management of their own health condition.”
She and her team are currently conducting a pilot study about the impact of the app’s use on clinical outcomes, with results expected later this year. So far, they are getting high praise from physicians, families and patients. For instance, the patients/families love that they can use the app to submit pre-visit reports instead of completing long paper forms in the waiting room. The clinical team, on the other hand, appreciates having a detailed view of patients’ symptoms or struggles before seeing them in clinic; it helps them understand what’s going on in their patients’ lives and better tailor treatment plans. The app also flags potential problems and shares them with the CF care team on a weekly basis, which allows for earlier intervention.
With the help of the Children’s CF care team, Oates hopes to transition Genia from research settings to a standard of care. Recently, the app was translated to Spanish and made available for both Android and Apple devices. This will allow it to reach a larger segment of CF families to help them manage daily care and better integrate their experiences in treatment plans.