Developing, Refining, and Testing a Mobile Health Question Prompt List in Gastroesophageal Reflux Disease

Project Summary Up to 42% of Americans with gastroesophageal reflux disease (GERD) experience uncontrolled, chronic symptoms that reduce health-related quality of life and heighten the risk of long-term complications. My long- term goal is to improve health outcomes for patients with esophageal disorders. This proposal aims to improve health outcomes for patients with GERD, by harnessing patient activation and motivating behavioral change as a framework for a mobile health (mHealth) Question Prompt List (QPL) intervention. Patient activation emphasizes patients’ knowledge, skills, and confidence in managing their health care and predicts patients’ level of health success. However, almost half of patients with GERD demonstrate low patient activation scores. Low patient activation leads to poor adherence to medical therapy. Remarkably, very little research has focused on developing an intervention to improve patient activation and motivate behavior change in GERD. Emerging evidence suggests effective patient-physician communication interventions, such as disease-specific QPLs, increase patient activation. The objective of this proposal is to apply a 5-step user-centered Design Thinking model to develop, refine, and test a mobile app based QPL specific for GERD patients titled “Esophagus-Qs.” The central hypothesis is that Esophagus-Qs will be usable and has potential to harness patient activation and motivate behavior change. Our specific aims include: 1) Develop the design of Esophagus-Qs by empathizing, defining the problems patients face, and ideating to generate solutions; 2) Refine the design of Esophagus-Qs by prototyping and testing usability; and 3) Collect preliminary data on Esophagus-Qs in a randomized controlled pilot study to estimate the effect size of the intervention. We will pursue these aims using an innovative combination of qualitative and quantitative methodologies and implementation science to inform app development. The proposed research is significant, because it has potential to harness patient activation and motivate behavior change, that can translate into improved health outcomes. It is also significant because it will develop a platform that can be extended to develop mHealth QPLs in other esophageal disorders. The proximate expected outcome of this work is to develop a usable Esophagus-Qs and collect preliminary data on differences in patient activation over time, medication adherence, health-related quality of life, and GERD symptom severity between Esophagus-Qs and standard of care. Pilot data from this career development award will be the foundation for an R01-funded clinical trial to rigorously test the efficacy of Esophagus-Qs among a large, diverse population.