Digitalising the personalised asthma action plan (PAAP) - a multi-perspective qualitative study

Asthma control can be optimised by medication compliance, trigger avoidance and recognising when and how to react to worsening control and asthma attacks. Failure to support this, by the under-issuing of personalised asthma action plans (PAAPs) by healthcare professionals (HCPs) and under-utilisation by patients, contributes substantially to asthma deaths (NRAD. RCP 2014;27). Since there is evidence that mobile applications can improve chronic disease health outcomes, we hypothesised PAAP digitalisation can improve current asthma self-management approaches. To assess whether and how a digital PAAP could address barriers to PAAP implementation, we performed focus group discussions with primary (n=3) and secondary (n=5) care doctors and nurses involved in asthma care, and patients (n=5) of variable age (18-65) and disease severity (moderate to poor asthma control over 1 year). Within group coding and categorisation contributed to a cross-case thematic framework for analysis. We found that patients and HCPs experience decision-making uncertainty using current PAAPs. In primary care, there is no uniformity in PAAP usage and methods to evaluate self-management efficacy. A digital PAAP would enable longitudinal data recording with objective monitoring capabilities. Patients valued the interactive, real-time support it could provide in affirming treatment escalation and medication choices. Nevertheless, a digital tool may have adverse effects, with concerns over data overload, quality and overdependence on technology. However, if built using a validated algorithm and in collaboration with key stakeholders, digital PAAPs could optimise self-management assessment and execution for patients and HCPs.