Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.

High performance terahertz resonant tunnelling diode sources and broadband antenna for air-side radiation

Resonant tunnelling diode (RTD) is known to be the fastest electronics device that can be fabricated in compact form and operate at room temperature with potential oscillation frequency up to 2.5 THz. The RTD device consists of a narrow band gap quantum well layer sandwiched between two thin wide band gap barriers layers. It exhibits negative differential resistance (NDR) region in its current-voltage (I-V) characteristics which is utilised in making oscillators. Up to date, the main challenge is producing high output power at high frequencies in particular. Although oscillation frequencies of ~ 2 THz have been already reported, the output power is in the range of micro-Watts. This thesis describes the systematic work on the design, fabrication, and characterisation of RTD-based oscillators in microwave/millimetre-wave monolithic integrated circuits (MMIC) form that can produce high output power and high oscillation frequency at the same time. Different MMIC RTD oscillator topologies were designed, fabricated, and characterised in this project which include: single RTD oscillator which employs one RTD device, double RTDs oscillator which employs two RTD devices connected in parallel, and coupled RTD oscillators which combine the powers of two oscillators over a single load, based on mutual coupling and which can employ up to four RTD devices. All oscillators employed relatively large size RTD devices for high power operation. The main challenge was to realise high oscillation frequency (~ 300 GHz) in MMIC form with the employed large sized RTD devices. To achieve this aim, proper designs of passive structures that can provide small values of resonating inductances were essential. These resonating inductance structures included shorted coplanar wave guide (CPW) and shorted microstrip transmission lines of low characteristics impedances Zo. Shorted transmission line of lower Zo has lower inductance per unit length. Thus, the geometrical dimensions would be relatively large and facilitate fabrication by low cost photolithography. A series of oscillators with oscillation frequencies in the J-band (220 – 325 GHz) range and output powers from 0.2 – 1.1 mW have been achieved in this project, and all were fabricated using photolithography. Theoretical estimation showed that higher oscillation frequencies (> 1 THz) can be achieved with the proposed MMIC RTD oscillators design in this project using photolithography with expected high power operation. Besides MMIC RTD oscillators, reported planar antennas for RTD-based oscillators were critically reviewed and the main challenges in designing high performance integrated antennas on large dielectric constant substrates are discussed in this thesis. A novel antenna was designed, simulated, fabricated, and characterised in this project. It was a bow-tie antenna with a tuning stub that has very wide bandwidth across the J-band. The antenna was diced and mounted on a reflector ground plane to alleviate the effect of the large dielectric constant substrate (InP) and radiates upwards to the air-side direction. The antenna was also investigated for integration with the all types of oscillators realised in this project. One port and two port antennas were designed, simulated, fabricated, and characterised and showed the suitability of integration with the single/double oscillator layout and the coupled oscillator layout, respectively.