Asthma is the most common chronic childhood condition and has significant adverse
consequences. One in 12 United States children has asthma, resulting in 13.4 million
missed school days, 1 million emergency department visits, and 140,000 hospitalizations
annually. Urban, minority, and underserved youth are disproportionally affected. On
Chicago's South Side, one-in-five children have an asthma diagnosis; over half visit an
urgent care or emergency department (55%), miss school (51.2%), or require parents to
miss work annually due to asthma (56.1%).
Effective self-management is crucial to optimize asthma care and improve outcomes. A key
barrier to self-management is the improper use of respiratory inhalers, which limits
disease control. Better inhaler technique is associated with improved asthma outcomes for
children. Assessment and education of inhaler technique are recommended at all healthcare
encounters; however, it is limited in practice because it is resource-intensive (both
personnel and time) and lacks fidelity. Thus, low-resource interventions that accurately
teach inhaler skills are needed to impact pediatric asthma outcomes.
Teach-to-Goal (TTG) is a patient-centered strategy that uses tailored rounds of teaching
and assessments to ensure mastery of inhaler technique. Studies show it is effective but
resource-intensive. A "virtual TTG" (V-TTG) intervention represents an opportunity to
deliver inhaler technique education with a high-fidelity, low-resource, and feasible
strategy. The module utilizes innovative learning technology with video demonstrations
and assessment questions to tailor education to each user; the cycles of assessment and
education continues until satisfactory mastery is achieved. Our team developed a V-TTG
intervention for adults with demonstrated efficacy. It remains unknown whether this
interactive and adaptive module will be feasible and effective in the pediatric
population due to varied developmental levels and parental involvement in care.
Virtual Teach-to-Goal (V-TTG) holds the potential to improve inhaler technique in
children; however, because learning theory indicates children and adults learn
differently, the same learning module cannot be utilized. We have already constructed
V-TTG for children with feedback from children with asthma, parents, and healthcare
professionals. The learning module is tailored for age by using developmentally and
age-appropriate vocabulary, concepts, format, and pacing.
