PURPOSE: Asthma action plans (AAPs) improve asthma morbidity. Reviews have noted important differences in the structure and content of AAPs and lack of a formal AAP development process by different authorities. We tested a wiki-based methodology to seek multiple-stakeholder input and agreement (respirologists, primary care physicians (PCPs), asthma educators (CAEs), patients with asthma) in defining the appropriate format and content of an adult AAP.
METHODS: We created a web-based template with drop-down menus containing choices for AAP content and format, based on: 1) current evidence (medical and human factors literature); 2) analysis of 69 existing AAPs; 3) asthma experts for content; 4) human factors design experts for format. Each of three groups (consisting of 3 respirologists, 2 PCPs, 2 CAEs, 7 patients each) serially used this tool to collaboratively author a single AAP by making multiple online selections over 1 week. Any member could alter choices made previously by other members. A web-log and comments section facilitated communication.
RESULTS: Eighteen heath care professionals (mean 16 years in practice, 52 asthma patients seen per month) and 21 patients (14 with symptoms ≥ 1 night per week) participated. Respirologists, PCPs, CAEs, and patients logged in a mean 4.4, 5.8, 6.4, and 7.1 times/week, for a mean 14, 16, 37, and 25 minutes/day, making a mean 6.3, 6.0, 7.2, and 9.3 changes/day to the AAP, respectively. The mean System Usability Score was 76 ± 20. Most found the tool effective (27/35) and were satisfied with the final AAP (28/35). The AAPs created by each of the 3 groups shared many format and content features.
CONCLUSION: A wiki-based process for multi-stakeholder AAP design had a high level of system usability and user engagement, and was found to be effective by most participants.
CLINICAL IMPLICATIONS: This method could economically bring geographically dispersed stakeholders together, and may mitigate hierarchical group dynamics experienced in face-to-face meetings. Common features between the AAPs created by this process could be combined into a single valid AAP which would reflect multi-user preferences.
DISCLOSURE: Samir Gupta, No Financial Disclosure Information; No Product/Research Disclosure Information