Optimizing a Sensor-Enabled mHealth Intervention for Adolescents With Suboptimal Asthma Control

We will compute frequency statistics to ensure we met our recruitment goal of 50% of the sample self-identifying as a racial/ethnic minority.

Retention will be calculated for study arms and compared to the hypothesized rate in one-sample tests. Retention rates for sex subgroups within each arm will also be examined descriptively. Consistent with evidence-based medicine recommendations for evaluating clinical trials, our criterion for success is no more than 20% attrition.

Engagement will be considered a success if the intervention and control groups complete an average of 4/7 (57%) symptom monitoring messages each week.

The ReAct Satisfaction Questionnaire is an 8-item modification of the Client Satisfaction Questionnaire that assesses overall participant satisfaction with the ReACT intervention. Participants respond on a 4-point scale.

System Usability Scale

We will use the Perceived Ease of Use subscale of the ITUES to measure burden. The subscale consists of 5 items.

We will conduct qualitative interviews with 20% of participants who complete ReACT we will administer a semi-structured interview with questions about features, usability, general impressions, and solicit unstructured feedback.

The Asthma Control Test (ACT) is a brief, standardized patient-reported outcome measure used to assess current asthma control from the patient's perspective. It is widely used in clinical practice and research to monitor symptom control and guide treatment decisions.

The ACT contains 5 items assessing:

Frequency of shortness of breath Nighttime awakenings due to asthma Interference with daily activities Use of rescue medication Overall self-rating of asthma control Response format and scoring Each item is rated on a 5-point Likert scale Total score ranges from 5 to 25 25 = completely controlled 20-24 = well controlled <20 = not well controlled (often used as a clinical cutoff) Higher scores indicate better asthma control

The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) is a disease-specific, patient-reported outcome measure designed to assess how asthma affects the daily functioning and well-being of children.

The standard PAQLQ contains 23 items across three domains:

Symptoms (10 items) Assesses the frequency and severity of asthma symptoms such as wheezing, shortness of breath, chest tightness, coughing, and nocturnal symptoms.

Activity Limitation (5 items) Measures limitations in physical, social, and daily activities due to asthma. Three activities are individualized: each child identifies activities most affected by their asthma.

Two items assess general activity limitations. Emotional Function (8 items) Captures emotional responses to asthma, including frustration, fear, concern, anger, or feeling different from peers.

The Adolescent Self-Regulatory Inventory (ASRI) is a self-report measure of self-regulation designed to assess adolescents' capacity to plan, monitor, and control their thoughts, emotions, and behaviors across situations. It is grounded in developmental theory emphasizing the gradual maturation of executive and regulatory processes during adolescence.

The ASRI includes 36 items organized into two higher-order dimensions:

Short-Term Self-Regulation (STSR)

Reflects regulation of immediate impulses and emotions, including:

Acting without thinking Difficulty controlling anger or frustration Problems delaying gratification Long-Term Self-Regulation (LTSR)

Reflects regulation in service of future-oriented goals, including:

Planning ahead Persistence Working toward long-term objectives despite obstacles These dimensions capture the developmental tension in adolescence between immediate reward sensitivity and emerging executive control.