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Although digital health tools are increasingly recognized as effective in improving clinical outcomes such as asthma control and medication adherence, few studies have assessed patient experiences and perception of value.
The aim of this study was to evaluate patient satisfaction, perception of usability and value, and desire to continue after 12 months of using a digital health intervention to support asthma management.
Participants were enrolled in a randomized controlled study evaluating the impact of a digital health platform for asthma management. Participants used electronic inhaler sensors to track medication use and accessed their information in a digital health platform. Electronic surveys were administered to intervention arm participants aged 12 years and older after 12 months of use. The survey assessed asthma control, patient satisfaction with the sensor device, and perception of the usability and value of the digital health platform through closed-ended and open-ended questions. Logistic regression models were used to assess the impact of participants’ characteristics on survey completion, satisfaction, and perception of value.
Of the 207 intervention arm participants aged 12 years and older, 89 submitted survey responses (42.9% response rate). Of these 89 participants, 70 reported being very satisfied (79%, 70/89) or somewhat satisfied (20%, 18/89) with the inhaler sensor device. Moreover, 93% (83/89) expressed satisfaction with the reports, and 90% (80/89) found the information from the reports useful for learning about their asthma. In addition, 72% (64/89) of the participants reported that they were interested in continuing to use the sensor and platform beyond the study. There were no significant differences in satisfaction with the device or the platform across participants’ characteristics, including device type, age, sex, insurance type, asthma control, or syncing history; however, participants with smartphones and longer participation were more likely to take the survey.
Electronic sensors and a digital health platform were well received by participants who reported satisfaction and perceived value. These results were consistent across multiple participants’ characteristics. These findings can add to a limited literature to keep improving digital health interventions and ensure the meaningful and enduring impact on patient outcomes.
The health impact and economic costs of asthma are significant, with the annual direct costs approaching US $50.1 billion and indirect costs such as lost productivity contributing an additional US $5.9 billion [
Digital health interventions have been used increasingly in self-management interventions for asthma. For example, the development of mobile apps for asthma management doubled between 2011 and 2013 [
Better understanding of how patients perceive and use digital health interventions to achieve improved outcomes is of utmost importance; however, there have only been a few studies published that focused on this topic. A recent review of digital health interventions across multiple diseases found that usability was assessed in only 33% of studies [
The study’s primary objective was to evaluate participant satisfaction, perception of usability and value, and overall experience after sustained use of a digital health intervention combining sensors, a mobile app, a Web dashboard, and email communication, to support asthma management in a real-world setting. The study also aimed to explore whether these perceptions would be influenced by specific participants’ characteristics such as age, gender, device ownership, insurance type, asthma control, and engagement. Improving the understanding of how diverse patients experience digital tools for asthma self-management will contribute to the success of these tools and the durability of their effects.
Participants were enrolled in a randomized controlled study to evaluate the impact of a Food and Drug Administration–cleared digital health platform on asthma outcomes including short-acting beta-agonist (SABA) use and asthma control. The digital health platform includes electronic inhaler sensors (Propeller Health, Madison, Wisconsin) that attach to inhaled asthma medications (
The data collected by the sensors are presented back to patients and health care providers through the digital health platform. The platform aims to promote disease awareness and self-management by enabling access to a patient’s own medication use data, including daily assessments of asthma control, adherence, identified triggers, and education based on the national guidelines (NHLBI 2007). The information is shared via a number of communication channels for all users, including weekly email reports, a Web-based dashboard, and a mobile app for smartphone users. Additional digital health platform details have been described elsewhere [
The clinical study enrolled adult and pediatric asthma patients (N=495) in parallel arms from specialty and primary care clinics at 2 sites in the Dignity Health system. Clinic staff enrolled eligible participants with the following inclusion criteria: over the age of 5 years, a provider diagnosis of asthma, presence of a SABA prescription at study inception, Spanish or English fluency, and absence of significant comorbidity such as chronic obstructive pulmonary disease. Further study detail is described elsewhere [
Participants were randomly assigned to either the intervention or control group and matched on sex, age, insurance type (public vs private), and baseline asthma control status (as defined by an Asthma Control Test [ACT] score ≤19 indicating a lack of asthma control) [
Surveys were administered electronically to participants in the intervention group who were aged 12 years or older at study completion at 12 months (N=207). The exit survey assessed asthma control with the ACT [
The survey consisted of open- and closed-ended questions, which evaluated satisfaction with the reports and information, satisfaction with the sensor device, learnings as a result of platform use, identified triggers, quality of communications with health care providers, suggestions for improving the reports and sensor, and interest in continued use of the platform. Detailed survey questions are included in
Closed-ended questions were analyzed by determining the percentage of respondents who selected each of the possible responses. Thematic analysis of the open-ended responses in the survey followed the structured approach described by Braun and Clarke [
We assessed participant engagement with the platform by evaluating the mean email open rate, number of push notifications received, and number of participant sign-ins to the dashboard or app. We used a logistic regression model to evaluate if there were differences between those participants who took the exit survey compared with those who did not across the following variables: age (12-17 years vs 18 years and over), sex, insurance type (public vs private), device type (smartphone vs hub), asthma control at intake (controlled vs uncontrolled), syncing duration (time between the first and last sync), and syncing frequency (number of syncs between the first and last sync). Using a logistic regression modeling approach, we also evaluated whether these variables were associated with participants’ responses to the closed-ended questions on device and report satisfaction, usefulness, and interest in continued use of the platform. Responses were grouped based on binary categories, for example, satisfied versus not satisfied, useful versus not useful.
Propeller Health sensor device, smartphone app, and hub base station. The Propeller sensor attaches directly to the metered dose inhaler and objectively captures the date, time, and frequency of medication use. The sensor transmits these data wirelessly via Bluetooth to a paired smartphone, where a mobile app displays the information for the user. For participants without a smartphone, a wireless hub transmits the data, which are accessible through a Web-based dashboard.
Of the intervention group participants (N=250), 207 met the requirement of being aged 12 years or older at study completion to receive the exit survey. A total of 89 participants completed the exit survey (
Among the 207 intervention group participants, the logistic regression model identified that participants who used smartphones (
Among the participants who completed the survey (N=89), on average, they synced their sensor for 361 days over the course of the study period (minimum: 264 days and maximum: 365 days). Participants synced their sensor 2149 times on average during the study or an average of 6 times per day. Participants also had a mean email open rate of 78%, received 35 push notifications, and had a mean 60 sign-ins to the patient dashboard, which represents more than 1 sign-in per week. The following results pertain to the 89 participants who completed the survey.
Participants reported their degree of satisfaction with the inhaler sensor device, with 79% (70/89) of respondents reporting “very satisfied,” 20% (18/89) reporting “somewhat satisfied,” and 1% (1/89) reporting “not at all satisfied” (
The majority of the participants (56%, 50/89) made no recommendations for sensor improvements. Of the participants who reported specific ideas for improvements (44%, 39/89), the most frequent response was for a longer battery life (20%, 18/89). Participants also reported wanting a smaller size device (13%, 12/89). The remaining participants reported wanting a more secure fit (4%, 4/89) or recommended additional features such as adding a dose counter (6%, 5/89).
Characteristics of participants who responded to the exit survey (N=89).
Characteristics of participants | n (%) | |
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Smartphone | 44 (49) |
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Hub | 45 (51) |
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Well controlled | 27 (30) |
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Not well controlled | 54 (61) |
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Unknown | 8 (9) |
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12-17 | 13 (15) |
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≥18 | 76 (85) |
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Female | 57 (64) |
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Male | 32 (36) |
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Private | 66 (74) |
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Public | 23 (26) |
Demographic and individual predictors of whether participants completed survey or not (N=207).
Characteristics of participants | Predictors of survey completion (N=207) | |
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Estimate (SE) | |
Device type (smartphone) | 1.154 (0.508) | .02 |
Age <18 years | 0.157 (0.640) | .81 |
Syncing duration | 0.063 (0.016) | <.001 |
Syncing frequency | 0.008 (0.002) | <.001 |
Sex (male) | 0.019 (0.438) | .97 |
Insurance (public) | −0.118 (0.481) | .81 |
Initial uncontrolled asthma | −0.686 (0.854) | .42 |
Initial well-controlled asthma | −0.471 (0.868) | .59 |
Participants’ responses to closed-ended questions: a) “How satisfied were you with the inhaler device?” b) “Overall, how satisfied were you with the reports?” and c) “How useful were the reports in helping you learn more about your asthma?”.
Primary themes, subthemes, and selected excerpts from open-ended responses about participants’ experience with the inhaler sensor device.
Primary and subthemes | Representative quotes | |
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Easy to use |
“It is easy to use.” “It was easy to operate.” |
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Easy to understand |
“Instructions for use are pretty straight forward.” “Easy to understand.” |
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Easy to maintain |
“Easy to attach to my inhaler.” “Easy to use [and] care for.” |
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Small |
“Small and compact.” “Small size.” |
Unobtrusive |
“Didn’t obstruct anything.” “Didn't get in the way.” “Not big or bulky which I liked.” |
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Portable |
“Easy to keep with you. Easy to carry.” “Fits in purse.” |
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Functioned well |
“Worked great.” “I liked that it worked wherever I went.” |
Participants reported on their satisfaction and perceptions of the reports’ usability and value in supporting their asthma management. A total of 60% (54/89) of the participants reported that they were “very satisfied” with the reports, 33% (29/89) were “somewhat satisfied,” and 7% (6/89) were “not at all satisfied” (
Moreover, 33 (37%, 33/89) of participants reported liking the content of the reports, including informative (9%, 8/89), actionable (6%, 5/89), and easy to understand (8%, 7/89;
Participants responded the information was “very useful” (45%, 40/89), “somewhat useful” (45%, 40/89), or “not at all useful” (10%, 9/89) in learning about their asthma (
The participants reported several learnings from using the digital platform (
A second primary theme focused on improved self-awareness. A total of 19 participants (21%, 19/89) specifically reported learning from monitoring the timing, location, and frequency of their medication use. Moreover, 10 participants (11%, 10/89) described learning strategies for managing their asthma such as taking their controller medications and avoiding specific triggers. Furthermore, 6 participants (7%, 6/89) reported that they discovered they were not as in control of their asthma as they had believed or they confirmed that their treatment plan helped them stay controlled. In addition, 5 participants (6%, 5/89) learned that they are accountable for their self-management and have the capacity to control their asthma. Participants could opt to discuss their data with their providers; 46% (41/89) of the participants reported that they had conversations with their providers about their data.
Some participants reported not learning anything from the reports: 16 participants (18%, 16/89) reported “none,” and 3 participants (3%, 3/89) reported not learning anything because they were already well controlled.
Primary themes, subthemes, and selected excerpts from open-ended responses about participants’ experience with the data reports.
Primary and subthemes | Representative quotes | |
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Informative |
“Very informative.” “They contained relevant information.” |
Actionable |
“Tells you about asthma so I can control it.” “Indicate to me where and when I needed to improve my surroundings to limit asthma problems.” |
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Easy to understand |
“Easy to read and understand.” “Easy to read [and] interpret.” |
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Display (visual) |
“Being able to see the data was helpful.” “Seeing a visual.” |
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Frequency |
“Regular feedback.” “Timely” |
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Triggers |
“Helped me try to focus on what my triggers are.” “Kept up to date, let me know weather and pollen count.” |
Timing and location of medication use |
“I could see how often I was using the medication as well as the location.” “GPS [Global Positioning Systems] locations of incidents is nice.” |
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Control |
“Tell me how well my asthma was controlled or not controlled.” “Helps to show tracking of asthma control.” |
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Frequency of medication use |
“Knowing the actual number of time I needed meds.” “Kept me conscious of regular use of meds.” |
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General understanding |
“Told me how I was managing.” “They just allowed me to see the general picture about my condition.” |
Participants were asked to provide suggestions for improving the reports or platform. A total of 59 participants (66%, 59/89) reported no improvements were needed, and 11 participants (12%, 11/89) responded with “not sure” or “no comment.” The remaining responses (21%, 19/89) offered specific suggestions including more educational content on how to improve asthma, information about how to subsidize medication costs, improvements in the app login process, additional customization options for how to receive reports, changing the cadence of the reports, and extending the sensor battery life.
The final question of the survey asked participants whether they would like to continue using the digital intervention: 72% (64/89) of the participants reported that they were interested in continuing to use the sensor and platform beyond the study. There were no significant differences among those participants who were interested in continuing or those who were not based on a participant’s device type, age, gender, insurance type, syncing history, or asthma control at intake (see
Primary themes and subthemes of participant learnings as a result of the digital intervention.
Primary and subthemes | Representative quotes | |
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Specific triggers |
“Worsens a lot with exercise.” “Stress can bring on symptoms.” |
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To be aware of triggers |
“Should pay more attention to what triggers attacks.” “I pay closer attention to my triggers.” |
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Value of being aware of triggers |
“Discovering the triggers of your asthma can better help you control it.” “By being aware of the pollen count assist in what activities to do when.” |
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General awareness |
“It made me much more aware of the use of my inhaler.” “How often I was using my inhaler.” |
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Timing and location |
“Learned that my asthma bothers me more at night and windy areas.” “I learned a lot about when and where my attacks were at.” |
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New insights |
“I learned how well my asthma was controlled through those reports.” “That it wasn't as controlled as I thought.” |
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Confirmation of control status |
“I confirmed that my asthma is well-controlled with my current medication.” “It confirmed the combination of avoidance of known triggers and the medication keeps it well managed.” |
Management strategies |
“To make sure to take the preventative every time.” “How to stay away from what triggers my asthma.” |
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Management beliefs |
“That I can control it better if I try.” “The program makes you accountable for taking the steps to control the asthma.” |
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Ways to communicate with doctor |
“I was never sure how often I used my rescue inhaler. When my doctor asked I could not give him an accurate response and now I can.” “I learned that I need to talk to my doctor about my asthma during [and] post workouts.” |
Participants were satisfied with the digital health intervention for managing their asthma and perceived value in using the technology to support their self-management. Participants reported improving their awareness, learning about trends in their medication use, identifying new triggers, and objectively monitoring how well their asthma is controlled, which they could discuss with their doctor. Participants shared helpful feedback regarding areas for improvement including interest in longer battery life and smaller size of the device.
We saw no significant differences in the degree of satisfaction and perceived usability across participants regardless of participant age, gender, insurance type, asthma control, technology adoption, and syncing duration. However, we did observe that those with a smartphone and a longer record of syncing were more likely to take the survey in the first place, which could have biased the sample toward more engaged, more technologically savvy participants. Despite this potential bias, these results add to the limited evidence exploring patient perspectives on digital health tools across diverse participants and shed light on the perceived benefits of the tools as well as opportunities for improvement.
These findings align with and supplement the existing evidence [
First, participants frequently emphasized ease of use for the inhaler sensor in terms of deployment, comprehension, maintenance, size, and convenience. Similarly, in a small study of adolescent asthma participants, patients cited the importance of the device not drawing any attention, being small in size, and being easily portable [
Second, participants in this study and others have reported that having objective data leads to increased self-awareness. This finding aligns with the self-regulation model for chronic disease and the more refined version for asthma management [
Improved confidence in one’s ability to self-manage, as was seen in some of the open-ended responses, is promising, but further investigation is needed to evaluate the intervention’s impact on self-efficacy. The survey design did not include specific questions to assess self-efficacy; therefore, we are unable to determine if the intervention had an impact on self-efficacy. Future studies evaluating digital interventions for asthma should thoroughly evaluate self-efficacy using validated self-efficacy measures and surveys, such as the mini-Asthma Quality of Life Questionnaire [
Third, this study found that participants value having information they can share with their clinical providers. Almost half of all participants had spoken with their clinical provider about the data collected. A smaller subset reported using the data to request medication adjustments, therefore taking more responsibility for their management. These findings are supported in a study that found that 70% of patients wished to share their data with health teams [
Digital health tools can support the patient-provider relationship through shared decision making [
Fourth, this study identified areas for improvement that can inform digital health tool development in the future. Participants reported wanting a longer battery life for the sensors. This feedback helped inform the development of the latest version of the sensors, which use Bluetooth low energy technology, do not require charging, and have a battery life of 12-18 months. In addition, some participants reported an interest in a smaller device, which resulted in the development of a sensor with 30% reduced volume. Participants also reported desiring more personalization and customization in the notifications and reminders and requested multiple methods of communication so that they can select the method that works best for them at the right time. Ongoing work is underway to add personalization, customization, and new communication options. There is growing evidence in this study and others [
First, although the participants’ cohort was fairly diverse in age, insurance type, technology use, gender, and asthma control status, additional studies are needed to evaluate preferences in larger samples of different types of patients across race, pediatric versus adult, geographic diversity, and health literacy levels. For example, this survey was only administered to participants aged 12 years and older and therefore did not capture the young pediatric patient or caregiver perspective. Second, the response rate was 42.9%, and selection bias may have influenced the results. We did find that participants who used smartphones and those who remained in the program longer (defined by their sync duration) were more likely to take the survey in the first place. They may have experienced more value from a longer interaction with the intervention and reported as such on the survey. Future research should target individuals with early study attrition to ensure a more complete understanding of their perceptions of usability and satisfaction to enable scalability to all populations. Third, the infrastructure to capture more robust individual-level participant engagement data was limited, which prevented a more complete understanding of participant engagement and how this engagement may have influenced overall satisfaction and perception of utility. Fourth, the survey questions were not derived from validated measures and did not use standard Likert scales, which limited the generalizability of the results.
This study offers new insights about patient satisfaction, preferences, and perceptions of a digital health intervention for respiratory disease among a larger, fairly diverse cohort in a real-world setting after a prolonged period of use. Participants reported satisfaction with the sensor device and reports and particularly valued the ability to integrate the device into everyday life, the provision of accessible and meaningful information to improve self-awareness, and the enhancement of communication with health care providers. As the use of digital tools in health care expands, it will be critical to learn from patient preferences and experiences to ensure that the tools fit well into their daily life and support their self-management.
Survey questions.
Participants’ responses to the closed-ended question, “How satisfied were you with the inhaler device?” by demographic and individual characteristics.
Participants’ responses to the closed-ended question, “Overall, how satisfied were you with the reports?” by demographic and individual characteristics.
Participants’ responses to the closed-ended question, “How useful were the reports in helping you learn more about your asthma?” by demographic and individual characteristics.
Participants’ responses to the closed-ended question, “How interested would you be in continuing to track your asthma medication use with this program?” by demographic and individual characteristics.
Asthma Control Test
The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire
short-acting beta-agonist
The authors would like to thank all the participants and the research coordinator responsible for administering the surveys.
DVS, KH, MB, JR, and DS are Propeller Health employees and receive salary and stock options. RM, RI, and JGS report no conflicts.