Outcome Measures of Efficacy Associated with a Web-Enabled Asthma Self-Management Programme: Findings from a Quasi-Experiment

Objective: To assess the efficacy of a World Wide Web-enabled asthma self-management intervention on quality-of-life indicators among self-selected participants with asthma. Design: A quasi-experimental design was used in which quality-of-life outcome indicators were derived from the Mini Asthma Quality of Life Questionnaire (MiniAQLQ); this self-administered instrument includes a global score and 4 domain scores (emotional status, environmental triggers, symptoms and activity restrictions). Baseline and re-measure scores were statistically tested for change over a 6-month period of engaged participation. Intervention: The web-enabled interactive MyAsthma(TM) intervention which builds on patient-centred self-management skills based on education, appropriate medication usage and symptom control. Participants: A national sample of 437 patients with self-reported symptoms of mild intermittent to severe asthma who registered as participants in MyAsthma(TM). Engaged use of the Internet for building asthma self-management skills was examined as a construct of participation in the intervention. Main outcome measures and results: Based on participants' self-reported responses, high volume users of the web-enabled intervention reported improved quality-of-life scores that were both statistically and clinically significant. Participants with a documented number of site visits greater than the group median (17 or more visits over the 6-month period of observation) were 1.6 times more likely to report an improvement in their global MiniAQLQ score compared with participants with less than the median number of visits [adjusted odds ratio (OR) = 1.60, 95% confidence interval (CI) 1.03, 2.48]. A similar effect associated with website visit frequency was observed with respect to participants' emotional subscales scores (adjusted OR = 1.76, 95% CI 1.09, 2.85) and activity subscale scores (adjusted OR = 1.64, 95% CI 1.06, 2.55). Conclusions: Based on pre-/post-test measures derived from a standardised and validated instrument, the web-enabled MyAsthma(TM) self-management programme was associated with a positive change in patient reported scores of quality of life. Although these results are preliminary and not derived from rigorously controlled clinical trials, the strength of this evidence is noteworthy nonetheless. We acknowledge that self-selection bias in observational studies is a threat to both internal and external validity. Research based on randomised clinical trials is needed to further document the effects of web-enabled disease management interventions targeting patients with asthma.