Effects of a digital motivational intervention on medication adherence and asthma control in Black emerging adults

To evaluate whether a technology-delivered, patient-centered motivational interviewing (MI) intervention improves medication adherence and asthma control among Black emerging adults with uncontrolled asthma.

In a randomized controlled trial, 152 Black emerging adults were randomized to two sessions of a technology-delivered MI intervention (n = 80) or an asthma education control (n = 72), with 30 days of text messaging between sessions. Assessments at baseline and 1, 3, 6, 9, and 12 months measured asthma control (Asthma Control Test [ACT]) and adherence (Ecological Momentary Assessment [EMA], the Brooks scale, and an investigator-developed percent-adherence measure). Adherence was the primary outcome and asthma control the secondary outcome. A linear latent growth curve model (LGCM) assessed EMA-based adherence (baseline, 3, 6, 12 months); piecewise LGCMs assessed asthma control and the remaining adherence measures across the one-month intervention and 11-month follow-up periods.

Compared with the control group, the intervention group showed significantly greater improvement in asthma control during the intervention period (β=1.14, p = 0.04, 95% CI [0.03, 2.26]), with no between-group change during follow-up (β=-0.01, p = 0.86, 95% CI [-0.13, 0.11]). The intervention did not affect adherence during the intervention (Brooks: β=0.35, p = 0.37, 95% CI [-0.41, 1.10]; percent adherence: β=4.15, p = 0.39, 95% CI [-5.29, 13.59]) or follow-up (Brooks: β=-0.03, p = 0.55, 95% CI [-0.11, 0.06]; percent adherence: β=-0.67, p = 0.19, 95% CI [-1.67, 0.33]), and had no effect on EMA-based adherence (β=-0.47, p = 0.48, 95% CI [-1.78, 0.83]).

A brief, technology-delivered MI intervention produced modest short-term improvements in asthma control among Black emerging adults.

Patient-centered motivational counseling delivered digitally is feasible and may modestly improve asthma control even without measurable adherence change, underscoring the value of communication strategies beyond medication instruction.