ASTHMAXcel Voice Study

NCT ID: NCT06935084

Last Updated: 2025-10-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-18

Study Completion Date

2028-09-30

Brief Summary

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The objective of this study is to conduct a randomized controlled trial (RCT) to compare the adapted and refined ASTHMAXcel Voice platform to usual care (UC). It is hypothesized by the investigator team that ASTHMAXcel Voice will be associated with improved clinical and process outcomes, asthma quality of life (QOL), medication adherence, and self-efficacy as compared to UC.

Detailed Description

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Poor outcomes for minority patients with asthma have been linked to poverty and other social determinants of health (SDOH), environmental exposures, and poor self-management. In a previous Agency for Healthcare Research and Quality (AHRQ)-funded study, the researchers developed and pilot tested ASTHMAXcel PRO, a mobile app that promotes self-management of asthma (NCT03847142). The app was optimized for outpatient settings and promoted asthma self-management through the collection of patient-reported outcomes (PROs), animated videos, goal setting, personalized algorithms, and push notifications. The use of the app led to significant decreases in the need for steroids, visits for asthma to the emergency department, and hospitalizations for asthma.

In this current research, ASTHMAXcel Voice, an app developed and refined during enhancement of ASTHMAXcel PRO, will make use of voice biomarkers to detect worsening symptoms. This technology uses machine learning to assess respiratory dysfunction, including asthma, based on a 6-second voice sample. From the sample, a Respiratory Symptoms Risk Score (RSRS) is calculated that correlates with the speaker's risk of respiratory impairment. The updated platform will calculate the patient's RSRS; facilitate shared decision making, screen for SDoH, and referrals; improve the ability of patients to self-manage; and allow for remote care coordination.

This program draws upon the Common Sense Model (CSM) of Self-Regulation which describes a cognitive processing system that includes situational stimuli (asthma symptoms), objective representation of the health threat (illness representations) with its treatment decision (controller medication use), and appraisal of outcomes (asthma control) for the success/failure of those treatment decisions. The model contains a feedback loop with illness representations changing over time as patients gain experience with asthma management. Social Determinants of Health (SDoH) may also affect the representation of the health threat, treatment decisions, and appraisal of outcomes. As an example, a patient with depression, a poor social support network, insecure housing, and financial stress may view asthma as an acute disease that is uncontrollable, which in turn leads to negative beliefs about medications and low self-efficacy towards asthma management. ASTHMAXcel Voice strives to shift illness representations away from the belief that asthma only exists when there are active symptoms and change behavior towards daily controller medication use over the long term to prevent asthma symptoms. Realtime feedback based on voice samples that yield a RSRS (voice biomarker) will help the patient to accurately detect perceived threats and manage asthma exacerbations during earlier stages. ASTHMAXcel Voice is also based on the SEM that addresses causes of poor asthma control across four interconnected domains: community, medical system, interpersonal, and individual level factors. ASTHMAXcel Voice is a multilevel approach to address these barriers with intervention components that are directly applied at each level.

There is growing recognition that mobile health interventions can be applied across all these levels to facilitate health behavior change through the use of push notifications and interactive educational content. ASTHMAXcel Voice works on the individual and interpersonal levels by providing targeted asthma education and push notifications to assist with medication adherence and asthma management. Worse outcomes assessed by PROs (asthma control) and voice biomarkers may heighten the perceived threat level of asthma and prompt Just-in-Time Adaptive Interventions (JITAIs) to seek out the educational content more frequently to improve asthma control. On the organizational (medical system) level, ASTHMAXcel Voice will facilitate shared decision-making and ongoing communication between the patient, Community Health Worker (CHW) or Social Worker (SW), and Health Care Provider (HCP). For example, a monthly visual dashboard display will increase HCP awareness of deteriorating trends assessed from PROs and voice biomarkers. On the community level, the CHW or SW will provide patients with SDoH relevant community resources (e.g., pest remediation services, smoking cessation programs, support groups, food pantries) to address SDoH concerns reported in the mobile platform. Finally, to inform more effective design and implementation of ASTHMAXcel Voice, the study team will use the Unified Theory of Acceptance and use of Technology (UTAUT) health IT framework in determining a user's technology acceptance and adoption behavior.

Conditions

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Asthma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be randomized in a 1:1 ratio into one of two arms: ASTHMAXcel Voice or Usual Care (UC) arms. Block randomization (block size: 10) will be used for the purpose of balancing arms within each block. The randomization scheme will be prepared by the study statistician who will not be on study site.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Research assistants who administer questionnaires via the Electronic Data Capture (EDC) system will be blinded. Outcomes Assessors will not be blinded.

Study Groups

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ASTHMAXcel

Participants in this arm will be provided with the adapted and refined ASTHMAXcel Voice platform.

Group Type EXPERIMENTAL

ASTHMAXcel Voice platform

Intervention Type OTHER

ASTHMAXcel Voice is a mobile health application with a multi-level approach to address barriers with intervention components and facilitate health behavior change through the use of push notifications and interactive educational content.

Usual Care (UC)

Participants in this arm will receive standard care.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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ASTHMAXcel Voice platform

ASTHMAXcel Voice is a mobile health application with a multi-level approach to address barriers with intervention components and facilitate health behavior change through the use of push notifications and interactive educational content.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* English speaking
* Persistent asthma (diagnosed by a healthcare provider) on a daily controller medication
* Able to provide informed consent
* Smartphone access (iOS or Android) with data plan

Exclusion Criteria

* Pregnancy
* Severe psychiatric or cognitive problems that would prohibit completion of protocol
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Yeshiva University

OTHER

Sponsor Role collaborator

Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role collaborator

Montefiore Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sunit Jariwala, MD

Role: PRINCIPAL_INVESTIGATOR

Montefiore Medical Center

Locations

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Montefiore Medical Center

The Bronx, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Sunit Jariwala, MD

Role: CONTACT

609-937-1023

Juliana D Rodriguez, MD

Role: CONTACT

Facility Contacts

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Sunit Jariwala, MD

Role: primary

609-937-1023

Juliana D Rodriguez, MD

Role: backup

References

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Reference Type BACKGROUND
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Kriston L, Scholl I, Holzel L, Simon D, Loh A, Harter M. The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns. 2010 Jul;80(1):94-9. doi: 10.1016/j.pec.2009.09.034. Epub 2009 Oct 30.

Reference Type BACKGROUND
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Juniper EF, Guyatt GH, Cox FM, Ferrie PJ, King DR. Development and validation of the Mini Asthma Quality of Life Questionnaire. Eur Respir J. 1999 Jul;14(1):32-8. doi: 10.1034/j.1399-3003.1999.14a08.x.

Reference Type BACKGROUND
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Chan AHY, Horne R, Hankins M, Chisari C. The Medication Adherence Report Scale: A measurement tool for eliciting patients' reports of nonadherence. Br J Clin Pharmacol. 2020 Jul;86(7):1281-1288. doi: 10.1111/bcp.14193. Epub 2020 May 18.

Reference Type BACKGROUND
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Ritter PL, Lorig K. The English and Spanish Self-Efficacy to Manage Chronic Disease Scale measures were validated using multiple studies. J Clin Epidemiol. 2014 Nov;67(11):1265-73. doi: 10.1016/j.jclinepi.2014.06.009. Epub 2014 Aug 3.

Reference Type BACKGROUND
PMID: 25091546 (View on PubMed)

Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999 Sep;89(9):1322-7. doi: 10.2105/ajph.89.9.1322.

Reference Type BACKGROUND
PMID: 10474547 (View on PubMed)

Leventhal H, Brissette, I., Leventhal, E. A. The common sense model of self-regulation of health and illness. In: Cameron LD, Leventhal, H., ed. The self-regulation of health and illness behavior. London, UK: Taylor and Francis Books; 2003:42-65.

Reference Type BACKGROUND

Sofianou A, Martynenko M, Wolf MS, Wisnivesky JP, Krauskopf K, Wilson EA, Goel MS, Leventhal H, Halm EA, Federman AD. Asthma beliefs are associated with medication adherence in older asthmatics. J Gen Intern Med. 2013 Jan;28(1):67-73. doi: 10.1007/s11606-012-2160-z. Epub 2012 Aug 10.

Reference Type BACKGROUND
PMID: 22878848 (View on PubMed)

Arcoleo KJ, McGovern C, Kaur K, Halterman JS, Mammen J, Crean H, Rastogi D, Feldman JM. Longitudinal Patterns of Mexican and Puerto Rican Children's Asthma Controller Medication Adherence and Acute Healthcare Use. Ann Am Thorac Soc. 2019 Jun;16(6):715-723. doi: 10.1513/AnnalsATS.201807-462OC.

Reference Type BACKGROUND
PMID: 30860858 (View on PubMed)

U B. Toward an experimental ecology of human development. American Psychologist. 1977;32(7):513 531.

Reference Type BACKGROUND

Kolff CA, Scott VP, Stockwell MS. The use of technology to promote vaccination: A social ecological model based framework. Hum Vaccin Immunother. 2018 Jul 3;14(7):1636-1646. doi: 10.1080/21645515.2018.1477458. Epub 2018 Jul 3.

Reference Type BACKGROUND
PMID: 29781750 (View on PubMed)

Venkatesh V MM, Davis GB, Davis FD. User acceptance of information technology: Toward a unified view. MIS quarterly. 2003;1:425-478.

Reference Type BACKGROUND

U.S. Department of Health and Human Services NIoH. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3). 2007 Jul.

Reference Type BACKGROUND

Schatz M, Kosinski M, Yarlas AS, Hanlon J, Watson ME, Jhingran P. The minimally important difference of the Asthma Control Test. J Allergy Clin Immunol. 2009 Oct;124(4):719-23.e1. doi: 10.1016/j.jaci.2009.06.053. Epub 2009 Sep 19.

Reference Type BACKGROUND
PMID: 19767070 (View on PubMed)

Hsia BC, Wu S, Mowrey WB, Jariwala SP. Evaluating the ASTHMAXcel Mobile Application Regarding Asthma Knowledge and Clinical Outcomes. Respir Care. 2020 Aug;65(8):1112-1119. doi: 10.4187/respcare.07550. Epub 2020 Jun 2.

Reference Type BACKGROUND
PMID: 32487751 (View on PubMed)

Hanson JL, Balmer DF, Giardino AP. Qualitative research methods for medical educators. Acad Pediatr. 2011 Sep-Oct;11(5):375-86. doi: 10.1016/j.acap.2011.05.001. Epub 2011 Jul 23.

Reference Type BACKGROUND
PMID: 21783450 (View on PubMed)

Hsia B, Mowrey W, Keskin T, Wu S, Aita R, Kwak L, Ferastraoarou D, Rosenstreich D, Jariwala SP. Developing and pilot testing ASTHMAXcel, a mobile app for adults with asthma. J Asthma. 2021 Jun;58(6):834-847. doi: 10.1080/02770903.2020.1728770. Epub 2020 Feb 19.

Reference Type BACKGROUND
PMID: 32046564 (View on PubMed)

Figueroa JF, Frakt AB, Jha AK. Addressing Social Determinants of Health: Time for a Polysocial Risk Score. JAMA. 2020 Apr 28;323(16):1553-1554. doi: 10.1001/jama.2020.2436. No abstract available.

Reference Type BACKGROUND
PMID: 32242887 (View on PubMed)

Other Identifiers

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2025-16587

Identifier Type: -

Identifier Source: org_study_id

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