Planning a digital intervention for adolescents with asthma (BREATHE4T): a, theory-, evidence- and Person-Based Approach to identify key behavioural issues

Stephanie Easton, Ben Ainsworth, Mike Thomas, Sue Latter, Rebecca Knibb, Amber Cook, Sam Wilding, Michael Bahrami-Hessari, Erika Kennington, Denise Gibson, Hannah Wilkins, Lucy Yardley, Graham Roberts

Research output: Contribution to journalReview articlepeer-review

3 Citations (SciVal)


Objectives: To describe a transparent approach to planning a digital intervention for adolescents to self-manage their asthma using breathing retraining (BRT), based on an existing, effective adult intervention (BREATHE). Methods: A theory-, evidence-, and Person-Based Approach was used to maximise the effectiveness and persuasiveness of the intervention. A scoping review and semistructured interviews with target intervention users (N = 18, adolescents aged 12−17 years with asthma and parents) were carried out to explore user perspectives, barriers, and facilitators towards the intended behaviours and potential intervention features. The combined evidence was used alongside and to inform theory-based activities and enabled iterative planning of the intervention. Results: The scoping review identified themes relating to user-specific self-management issues, content, education, training needs, and features for a digital intervention. Interviews elicited potential barriers to intended behaviours such as the anticipated embarrassment of using BRT and concerns around remaining calm. Facilitators included BRT delivered by adolescents who share experiences of asthma and information for performing exercises discreetly. Relevant theoretical frameworks ensured that appropriate psychological constructs were targeted. A behavioural analysis identified six intervention functions and thirty behaviour change techniques. Logic modelling mapped the programme theory and mechanisms, which aims to improve adolescent asthma-related quality of life. Conclusions: This study gives a transparent insight into the approach followed to plan a self-guided BRT intervention for adolescents and has led to identification of key behavioural issues, enabling relevant intervention content to be chosen. Insight has been given into adolescent perceptions of BRT, which facilitated development of the prototype intervention.

Original languageEnglish
Pages (from-to)2589-2602
JournalPediatric Pulmonology
Issue number11
Early online date6 Aug 2022
Publication statusPublished - 30 Nov 2022

Bibliographical note

Funding Information:
We would like to thank the Trial Steering Committee Group members (Prof Steve Turner, Prof Gary Connett, Dr Hans Michael Haitchi, Dr Daniela Ghio, Amanda‐Lea Harris, Emma Ray) for their support and feedback throughout the project. We'd also like to thank the patient and public members, parents (Svetlana Inwards, Stephanie Hamm, Trevor Ward, Sheryl Ward and Lynn Tann) and teenagers (Joshua Inwards, Amy Tann, Vikram Taak, Dante Texeira, Helena Ward, and Zoe Holley) for their continuing commitment and contribution to the project. Next, we'd like to thank Silverback Web‐Developers for developing the prototype Breathe4T website. We'd also like to thank the NIHR CRF, and paediatric asthma team at Southampton Hospital for their support. We'd like to thank Anne Bruton for her input in conceptualising the project, based on the adult BREATHE intervention. We'd like to thank Amy Whitehead and Simone Holley, for their relevant expertise in the design of the study. Finally, we'd like to thank our colleagues at Asthma UK, and Asthma + Lung UK Centre of Applied Research (AUKCAR) for their support with the project. This paper presents independent reseach funded by the National Institude of Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB‐PG‐0817‐20038). The views expressed are those of the authors and not necessary those of the NIHR or the Department of Health and Social Care.

Funding Information:
Mike Thomas, Lucy Yardley and Denise Gibson were coapplicants in the adult BREATHE study. The study was funded by NIHR RfPB. Erica Kennington is employed by Asthma Lung UK. The remaining authors declare no conflict of interest.


  • adolescence
  • asthma
  • breathing retraining
  • digital intervention
  • self-management

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine


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