HLTH 5443 Module 1 Health Technology Evaluation Example

A Sensor on the Inhaler: Evaluating Smart Inhaler Technology for Adolescents With Persistent Asthma in a County School Health Program

Student Name

American College of Education

HLTH5443: Technology, Leadership, and Health Informatics

Module 1 Assignment

Instructor Name

October 5, 2026

Introduction

A composite county health department runs a school health program that supports students with asthma in its middle and high schools. School nurses report that many teenagers with persistent asthma rarely take their daily controller inhalers, rely heavily on rescue inhalers and miss school during flare-ups. A vendor has offered the program a package of small sensors that clip onto inhalers and record each use, paired with a phone app that sends reminders and shows patterns to the student and, with consent, to a nurse or clinician. The program's manager has asked the health educator to evaluate whether the technology fits the program's adolescents before any purchase. This paper presents that evaluation.

The Population and Its Needs

Few chronic conditions touch as many American children as asthma. Zahran et al. (2018), analyzing national survey data, reported that 8.3% of U.S. children had asthma in 2016, with higher prevalence among Black children, children of Puerto Rican descent and children in low-income families, and that children aged 5 to 17 with asthma missed 13.8 million days of school in 2013. Adolescents present particular challenges. They take increasing responsibility for their own medications as parents step back, their routines are irregular, and many dislike taking medication in front of peers. Controller medicines work only when used daily, even when symptoms are absent, which is exactly the habit that teenagers find hardest to keep. In the county program, nurses estimate that fewer than half of students with persistent asthma use their controller inhaler most days.

How the Technology Works

The sensor attaches to the top or side of a standard metered-dose inhaler and records the date and time of each actuation. It connects by Bluetooth to an app on the student's phone. For a controller inhaler, the app sends reminders at scheduled times and tracks whether doses were taken. For a rescue inhaler, it logs each use, which can reveal patterns such as frequent use at night or during sports, signals that asthma is not well controlled. With permission, the data can be shared with a clinician or care manager through a web dashboard, allowing outreach when rescue use rises. Some versions add location and local air quality data to help identify triggers.

The Evidence

The strongest evidence concerns adherence. In a randomized trial of 220 school-aged children with asthma in New Zealand, an electronic monitoring device with an audiovisual reminder raised median adherence to inhaled corticosteroids to 84%, compared with 30% in the control group, and produced a greater improvement in asthma morbidity scores over six months (Chan et al., 2015). Notably, school absence did not differ between groups in that trial, a reminder that better adherence does not automatically translate into every outcome a school cares about. In a randomized trial of the Propeller Health platform among adults and children, monitoring rescue inhaler use reduced daily rescue use and increased rescue-free days compared with usual care, with improved asthma control among adults who began with uncontrolled asthma (Merchant et al., 2016). These trials suggest real benefits for adherence and rescue use, but few focused specifically on adolescents or on school-based programs, so the evidence must be applied to this population with caution.

Fit With Adolescent Users

Evidence of efficacy is only part of an evaluation; a technology must also be accepted by the people expected to use it. Davis (1989) proposed that people's acceptance of information technology depends largely on two beliefs: perceived usefulness, the degree to which they believe the technology will help them, and perceived ease of use, the degree to which using it will be free of effort. For teenagers, ease of use is favorable: the sensor works automatically once attached, and phone apps are familiar. Perceived usefulness is less certain. Adolescents who feel fine may not see the value of controller reminders, and some may view rescue-use tracking as surveillance by adults. Features that give the teen something of value, such as a personal view of triggers or fewer nurse visits, may matter more than features designed for clinicians.

Access and Equity

The technology assumes that each student has a compatible smartphone, a data plan and the habit of keeping Bluetooth on. In the county program, most teenagers have phones, but some share devices with family members, some have limited data and a few have no phone. Students in families that move frequently may lose sensors or chargers. If the program deployed sensors only to students with suitable phones, it could widen gaps between students who already have resources and those who do not. Any adoption plan must address device access, for example by providing low-cost phones or allowing sensor data to sync through a school device, and must offer alternatives such as nurse check-ins for students who cannot use the app.

Cost and Organizational Fit

The vendor's quoted price covers sensors, app access and a clinician dashboard on a per-student, per-year basis. For a pilot with 60 students, the cost is manageable within the program's grant, but scaling to all 400 students with persistent asthma would require new funding or insurance coverage. The program also needs staff time to enroll students, attach sensors, monitor dashboards and respond to alerts. Without a plan for who responds when a student's rescue use spikes, the data would add work without improving care. The technology fits the program only if nurses have time and clear protocols for using the information.

Alternatives Considered

A fair evaluation compares the technology with other ways of meeting the same need. The first alternative is directly observed therapy at school, in which students take their controller dose in the nurse's office each morning. It has produced good adherence in some school programs, costs little beyond nurse time and requires no phone, but it covers only school days, depends on students arriving on time and may feel stigmatizing to teenagers who do not want to be seen visiting the nurse daily. The second is simple text message reminders sent by the program, which are inexpensive and reach any phone, but they cannot confirm whether a dose was actually taken or show rescue inhaler patterns. The third is more frequent nurse check-ins using asthma control questionnaires, which build relationships but rely on students' recall. Each alternative has strengths, and the sensor's distinctive value is objective data on actual use, especially rescue use, which none of the others provide. That advantage justifies testing the sensors, while the alternatives remain useful for students who cannot or will not use them.

Recommendation

The evaluation supports a limited, carefully designed pilot rather than full adoption. The evidence shows meaningful gains in adherence and reductions in rescue use, ease of use is high and the tool addresses a real problem in the population. However, evidence specific to adolescents in school programs is thin, perceived usefulness among teens is uncertain, device access is uneven and staff capacity is limited. A one-semester pilot with about 60 volunteer students at two high schools, with provisions for students lacking suitable phones, clear nurse protocols and measures of adherence, rescue use, symptoms, absence and student satisfaction, would show whether the technology works in this setting. Later modules will examine how the program can use the data it generates, the access and literacy barriers involved and the privacy and compliance requirements that must be met.

References

Chan, A. H. Y., Stewart, A. W., Harrison, J., Camargo, C. A., Jr., Black, P. N., & Mitchell, E. A. (2015). The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: A randomised controlled trial. The Lancet Respiratory Medicine, 3(3), 210-219. https://doi.org/10.1016/S2213-2600(15)00008-9

Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319-340. https://doi.org/10.2307/249008

Merchant, R. K., Inamdar, R., & Quade, R. C. (2016). Effectiveness of population health management using the Propeller Health asthma platform: A randomized clinical trial. The Journal of Allergy and Clinical Immunology: In Practice, 4(3), 455-463. https://doi.org/10.1016/j.jaip.2015.11.022

Zahran, H. S., Bailey, C. M., Damon, S. A., Garbe, P. L., & Breysse, P. N. (2018). Vital signs: Asthma in children: United States, 2001-2016. MMWR. Morbidity and Mortality Weekly Report, 67(5), 149-155. https://doi.org/10.15585/mmwr.mm6705e1