. 2021 Aug 3;46(10):1195–1212. doi: 10.1093/jpepsy/jsab057

Table I.

Characteristics of Included Studies

Author (year)	Study design; control group format	Intervention description	Intervention frequency and length	N	Sample age (years) M ± SD (range); racial/ethnic majority group; majority sex	Measure of adherence	Main adherence findings
Abramson (2015)	Cluster RCT; Usual care	3-month spirometry with reports returned to the practice and regular medical review	4 visits over a 12-month period	72	Unable to extract M ± SD (8–17)^a; Not reported; Unable to extract	Subjective	Mean adherence improved over 12 months in the intervention group; however, there was no improvement in the control group (mean difference = 0.62, p = .14).
Bender (2015)	Pragmatic RCT; Usual care	Speech recognition telephone calls to parents were triggered when an ICS refill was due or overdue	As indicated for 24 months	899	8.2^b ± 0.13 (3–12)^a; 56.3% White; 64.2% male	Pharmacy refills	Adherence was higher in the intervention group than the usual care group, p < .001.
Britto (2017)	Longitudinal Crossover Study; Usual care during nonintervention period	Participants created and scheduled personalized text messages to be sent to their phones for tailored asthma management reminders	Access to asthma management messages for 3 months	22	Unable to extract M ± SD (12–22)^a; Unable to extract; Unable to extract	Electronic monitor	Intervention improved ICS adherence by 2.75% per month, p < .01.
Burgess (2010)	RCT; Attention control	Participants, their parents, and physicians received feedback from Smartinhaler on the child's adherence over the past month	Monthly visits for 4 months	26	9.1^b (6–13); Not reported; 69.2% male	Electronic monitor	Adherence was significantly higher in the intervention group, p < .01.
Butz (2006)	RCT; Asthma education control	Home-based asthma education, including symptom recognition, appropriate medication practice and healthcare use	6 home visits of 1-h sessions over 6 months	181	4.5 ± 2.1 (2–9); 89.1% African American; 65.6% male	Pharmacy refills	Mean number of ICS prescriptions were significantly higher for the control group, p = .02.
Butz (2010)	RCT; Asthma education control	Caregiver-clinician asthma communication skills education, assistance in arranging clinician visits, and health educator attending child's primary care visits	4 home visits over an 8-week period plus attendance at primary care clinic visit over 6 months	156	8.0 ± 1.9 (6–12); 92.6% African American; 60.6% male	Pharmacy refills	Intervention participants trended towards a higher ICS to total asthma medication ratio at 12 months, p = .07.
Butz (2014)	RCT; Attention control consisting of home asthma education	Home asthma education visits, nurse attendance at child's PCP visit, and delivering clinician feedback letter	3 nurse visits over 4 months	274	(3–10)^a; 95.7% African American; 59.3% male	Pharmacy refills	No significant difference in mean change in ICS pharmacy refills from baseline to 12 months, p = .66.
Chan (2003)	Experimental versus control; Office-based traditional education control	Internet-based education and video monitoring system using store-and-forward technology	Education given at 2,6,12, and 24 weeks	10	7.6 ± 2.0 (6–17)^a; Not reported; 50% male, 50% female	Pharmacy refills	Adherence and refill rate for ICS was comparable and acceptable in both groups.
Chan (2015)	RCT; Attention control (no audiovisual reminders)	Electronic monitoring with audiovisual reminders enabled	Follow-up visits every 2 months for 6 months	220	8.9^b ± 2.5 (6–15)^a; 62.2% Non-European; 51.4% male	Electronic monitor	Median percentage ICS adherence was 84% in the intervention group, compared to 30% in control group.
Davis (2019)	RCT; Usual care	Question prompt list and short video about asthma self-management	Single session before seeing provider	296	13.1^b ± 2.9 (11–17)^a; 63.7% Non-African American; 58.9% male	Subjective	Group assignment was not associated with either caregiver or youth reported adherence.
Ducharme (2011)	Single-masked RCT; Usual care (unformatted prescription)	Written action plan plus formatted prescription provided during acute asthma care visit in ED	Single session intervention	211, 98^c	Median Age = 4^b (1–17)^a; 62.1% White; 60.3% male	Electronic monitor	Both groups had similar decline in adherence during the initial 14 days. Intervention group had significantly higher adherence between days 15–28.
Duncan (2013)	3-arm RCT^d; Asthma-education attention control	Parent–youth teamwork intervention focused on sharing responsibility for asthma management	4 sessions every 2–3 weeks spanning a 2-month period	29	11.1 ± 1.9 (9–15); 84.3% Caucasian; 59.4% male	Electronic monitor	Intervention produced significantly higher rates of ICS adherence compared to control.
Farber and Oliveria (2004)	RCT; Usual care	Basic asthma education and written asthma self-management plan as part of an ED visit	Single session and 3 brief follow-up phone calls within 3 months	50	7.5 (2–18); Not reported, authors note sample was predominantly African American; Not reported	Pharmacy refills	Intervention improved number of medication dispensing events compared to control group, p = .004.
Feldman (2012)	Non-randomized controlled study; Usual care (youth unable to see peak expiratory flow (PEF) feedback)	Children predicted their PEF and viewed their actual PEF values afterwards	Twice daily for 6 weeks	85	10.8^b ± 0.2 (7–15); 52.1% Puerto Rican; 57.3% male	Electronic monitor	Children in PEF-feedback group had better ICS adherence compared to children in PEF-feedback group, p < .01.
Garbutt (2015)	Pre-post; None	A peer-trainer provided tailored education, skill training, goals setting, and targeted asthma management as well as parenting support	Weekly to biweekly phone calls over 6 months	8	Unable to extract M ± SD (3–6); 50% Caucasian, 50% African American; Not reported	Unable to extract	ICS adherence went from 72% to 100%, p = .013.
Gustafson (2012)	RCT; Usual care plus asthma information control	eHealth program and monthly telephone call from asthma nurse case manager	Yearlong program with monthly telephone calls	259	7.7^b ± 2.6 (4–12); 56.8% African American; 61.1% male	Unable to extract	Adherence did not change significantly within or between groups.
Harrington (2018)	Pilot prospective RCT; Usual care (family administered ICS at home 2x/day)	School nurse administered morning ICS	60 days	46	8.2 ± 2.5 (K-8^th grade); 91.3% Non-Hispanic African American; 56.5% male	Subjective	No significant differences between groups, p = .06.
Hederos (2005)^e	Prospective RCT; Usual care	Parental support group meetings with providers following initial diagnosis	4 group meetings over 6-month period	60	2.3^b (0–6)^a; Not reported; 60.0% male	Subjective + Electronic monitor	Intervention group had higher objective adherence, p = .06. No significant group differences based on parent report of adherence.
Hederos (2009)^e	Prospective RCT; Usual care	Parental support group meetings with providers following initial diagnosis	4 group meetings over 6-month period	54	8.3^b (6–13)^a; Not reported; 61.1% male	Subjective	Doctor-reported adherence was higher in for the intervention group, p < .001. However, parent report indicated no between group differences.
Horner (2016)	3-arm RCT^d; Attention control (general health education)	Single asthma day camp with brief didactic presentations following Asthma Plan for Kids curriculum	Single day (4 hours of total content)	173	8.8^b ± 1.2 (2nd–5th grade); 60.7% Hispanic; 58.4% male	Unable to extract	No significant changes over time or group effects for ICS adherence.
Jan (2007)	RCT; Usual care plus educational handouts and written asthma diary	Internet-based multimedia asthma education with interactive asthma monitoring system	12-week access to web-based program	153	10.9^b ± 2.5 (6–12); Not reported; 61.6% female	Unclear	Rates of ICS adherence were higher in the intervention group than control, p < .05.
Johnson (2016)	RCT; Usual care	Subjects received SMS reminders at user-defined medication administration times	3-week access to scheduled SMS reminders	65	14.2^b ± 1.8 (12–17)^a; 51.7% Non-African American; 50.6% male	Subjective	Intervention patients had a significant improvement in self-reported 7-day adherence, compared to controls, p = .01.
Kenyon (2019)	RCT; Attention control (2 reminders to sync sensor)	Automated text message reminders to take ICS	Daily texts for 30 days	32	5.9 ± 2.1 (2–13); 85.4% African American; 53.7% male	Electronic monitor	No significant differences in mean adherence between intervention and control group.
Kosse (2019)	Cluster RCT; Usual care	Smartphone app, including asthma-related educational/motivational movies, medication reminder alarm, peer & pharmacist chat, adherence monitoring	6-month access to smartphone app	234	15.1 ± 1.9 (12–18)^a; 97.9% Dutch; 52.6% female	Subjective	Non-significant improvement in adherence in the intervention group compared to the control, p = .25.
Koumpagioti (2020)	RCT; Usual care	Asthma care educational program aimed to develop self-management skills, self-responsibility, and self-efficacy among newly diagnosed youth	45–60 min interactive session	78	8.4^b ± 2.8 (4–16)^a; Not reported; 64.1% male	Electronic monitor	Median percentage ICS adherence was significantly higher in the intervention compared to the control, p < .001.
Morton (2017)	RCT; Usual care (adherence monitoring alone)	Electronic monitoring with daily reminder alarms with feedback in the clinic regarding ICS use	Daily reminders plus routine clinic visits every 3 months for 1 year	77	10.4^b ± 2.9 (6–16)^a; 60.0% White British; 56.2% male	Electronic monitor	Average adherence was significantly higher in the intervention compared to the control, p ≤ .001.
Mosnaim (2013)	RCT; Attention control (doctor-recorded messages only)	Coping peer group support sessions using motivational interviewing approaches and peer-recorded asthma messages delivered via mp3 players	Weekly support sessions and access to mp3s over 10 weeks	46	13.4 (11–16); 86.8% Black; 52.9% female	Electronic monitor	No significant group differences in median adherence, p = .93.
Naar (2018)^e	RCT; Attention control (weekly in-home family supportive counseling)	Multisystemic therapy-healthcare intervention	Access to MST therapists for 6 months	167	13.3^b ± 1.3 (at baseline—see Naar-King et al., 2014) (12–16)^a; 100% African American; 61.1% male	Subjective	Intervention group demonstrated significantly greater improvements in adherence compared to the control, p = .03.
Naar-King (2014)^e	RCT; Attention control (weekly in-home family supportive counseling)	Multisystemic therapy-healthcare intervention	Access to MST therapists for 6 months	167	13.3^b ± 1.3 (12–16)^a; 100% African American; 61.1% male	Subjective	Intervention group demonstrated significantly greater improvements in adherence compared to the control, p = .03.
Otsuki (2009)	3-arm RCT^d; Home-based asthma education only	Home-based asthma education combined with medication adherence feedback	5 30- to 45- min home visits	167	6.5^b ± 3.3 (2–12)^a; 98.8% African American; 63.5% male	Pharmacy refills, Subjective	No significant differences between groups.
Riekert (2011)	Pre-post; None	Motivational interviewing-based asthma self-management program	5 30- to 40-min home visits	37	12.5 ± 1.6 (10–16)^a; 100% African American; 59.5% male	Subjective	No significant changes in mean ratings of ICS adherence based on either parent or youth-report.
Rohan (2013)	RCT; Usual care	Provider-delivered problem solving and adherence feedback	2–3 sessions (average length = 15 min) during routine medical care	11	8.5 ± 3.1 (5–14); 63.6% African American; 72.7% male	Electronic monitor	Intervention significantly increased adherence rates during the intervention period for all but one patient.
van Es (2001)	RCT; Usual care	Individual and group sessions with asthma nurse aimed to increase social support, enhance self-efficacy, and stimulate positive attitude	4.30-min individual visits with asthma nurse and 3.90-min group sessions over a year period	86	13.6^b ± 1.4 (11–18); 75.0% Caucasian; 51.8% male	Subjective	No significant differences post-intervention. Intervention group had higher adherence than the control group at 24 months, p = .05.
Vasbinder (2016)	RCT; Real-time medication monitoring without SMS reminders	Real-time medication monitoring with “time-tailored” SMS medication reminders when participants were at risk of missing a dose	As needed SMS reminders over a year period	209	7.8^b ± 2.2 (4–11)^a; 65.1% Dutch; 62.7% male	Electronic monitor	Mean adherence was higher in the intervention group, mean difference 12.0% (95% CI 6.7–17.7%).
Wiecha (2015)	Pilot RCT; Usual care plus asthma education manual and peak flow meter	Interactive educational website designed to promote adherence, enhance family-provider teamwork, and increase physician awareness of the child's asthma status	access to website for 6 months; feedback provided to family and provider every 2 months	30	11.9^b ± 2.0 (8–16); 58.6% Black; 58.6% male	Electronic monitor	Mean change in adherence was positive for the intervention group and negative for the control group; however, this difference was not statistically significant, p = .46.

Note. N = number of participants with adherence data; Not reported = Original study authors did not report this information; Unable to extract = Data could not be interpreted for the current study. ^aRecruited age range; ^bintervention group only, unable to calculate for full sample; ^cTwo hundred eleven participants were only prescribed ICS for 14 days, while 98 participants were prescribed ICS for >14 days; ^dFor Duncan et al. (2013) and Otsuki et al. (2009), we compared their primary multi-component interventions to their education-only attention-control groups. Horner et al. (2016) examined outcomes of the same intervention across two different settings and compared each to an attention control group; we compared their community-based day camp intervention, described as their primary intervention, to their attention control group. ^eTwo articles (Hederos et al., 2009; Naar et al., 2018) presented longitudinal follow-up of previously published studies (Hederos et al., 2005; Naar-King et al., 2014). The boldface text is used to indicate statistically significant results.