This is a quantitative study, in the form of a quasi-experimental, non-equivalent pre-test and post-test with control group design. According to (15). A quasi-experimental is a research design used to evaluate interventions that do not involve randomization (16). The researcher chose this design because of the inability to manipulate or control the environment and randomized subjects. Randomization is difficult in educational studies, and since this study took place in a group environment which included schoolchildren in classrooms, the sample could not be solely monitored by the researcher (17). This study design would also include research to assess the differences between the pre-test results of the study and control groups, variations between pre-test and post-test results, and variations between the post-test outcome of the study and control groups that are compatible with the particular objectives of this current study.
As shown in Figure 1, the participants were divided into two groups according to selected schools randomly. The schoolchildren in the experimental group were from different schools than those in the control group. In this study, the control group used only traditional methods (face-to-face) and the experimental group received education using a smartphone application. In addition, there employed ‘controlled before and after’, a control population with similar characteristics to the study population and are expected to have similar changes that occur to the study population (18). The outcome measures were assessed after 3 months, post-intervention, for both groups We chose randomly 6 schools located in Petaling Jaya city within the state of Selangor, Malaysia, then we randomly assigned the schools into 2 groups, 3 schools chose to consider as experimental group and 3 schools consider as control group, then we recruited schools children whose met the inclusion criteria. According to Brydges (19), the study sample sizes required for group differences research to achieve estimated medium effects size levels of 80% statistical power by using a prior power analysis with α=.05 (two-tailed), were 107 subjects are allocated to each group, so a total of 214 schoolchildren involved for the entire study. The inclusion criteria were students having asthma diagnosis, students showing asthma symptoms in the last 12 months, have smartphone and students who speak either English or Malay. The exclusion criteria were students who do not have significant comorbidity disease and students who refuse to participate in the study.
The Research Phases
This research was conducted in four phases. The first phase was constructing the health education program about bronchial asthma “Asthma Care Program®” and mobile application developing “MemahamiAsma®” that began with an extensive literature review. The second phase was conducting a quasi-experimental study which first used a survey to identify eligible participants according to the inclusion criteria by a pre-intervention assessment. The third phase the control groups attended the session face to face of health education regarding asthma, and the experimental group they received firstly face to face classroom learning for 1 hour, then after the face to face lecture, the mobile app-based learning was administering to the students for 3 months. The last phase was the follow-up three months after the health education intervention for the control and experimental groups using a self-administered questionnaire, similar to that at pre-health education intervention, to assess the schoolchildren’ HRQoL.
This part was developed by the researcher based on previous studies (3, 20-23). This data consists of the schoolchildren’s general information, their demographical status, gender, age, race, and family history of asthma. The aim of this questionnaire is to evaluate the correlation between demographic factors and HRQoL level among asthmatic schoolchildren.
Health-Related Quality of life of Questionnaire.
The questionnaire used to measure the health-related quality of life of the students was adopted from the Pediatric Asthma Quality of Life Questionnaire (PAQOLQ) which was designed and validated by Juniper et al. (1996). This instrument contains 23 questions in three domains (symptoms, activity limitations and emotional function). Children were asked to recall their experiences during the previous week and to respond to each question on a 7-point scale.
The tools of health education intervention
Educational pamphlet “Asthma Care Program®”
Asthma Care Program is the children asthma hand pamphlet developed by the researcher in both language English and Bahasa Malaysia based on the review of the literature and evaluation by a panel of experts. This tool designed to be colorful, entertaining, educational, and developmentally appropriate as well as diverse in regard to gender, race, and culture. The content of the workbook includes anatomy and physiology of the lungs, management, and prevention of disease. This hand workbook will distribute to the control group (Figure 2)
Mobile App “MemahamiAsma®”
Mobile asthma app called: MemahamiAsma® was developed by android developer specialist incorporation with research team in both language: English and Bahasa Malaysia to support children with asthma for their daily care. The mobile app is electronic alternative for hand workbook tool that contain all data need for asthma and can support school children about asthma.
App design process
The design process of MemahamiAsma® is based on the goal-directed design (GDD) (24) and Health Literacy Online’s six main strategies (25). To simplify the process of the design, modifications were made to both aforementioned methods by dividing the design process into four stages covering the two phases of development and deployment. Figure 3 depicts the proposed design process of MemahamiAsm
Understanding Asthma or MemahamiAsma® is a simple-to-use and straight-to-the-point android application for high school students from Malaysia. The application is developed in both English and Malay as shown in Figure 4.
In the first page that the user will see login page. They have to enter their login ID and password. The user then has to choose their preferred language, either English or Malay. After choosing their language, the user will be greeted by this page. The tabbed page is populated with INFO, tabs on asthma information as well as tabs on frequently asked questions (FAQ). The last page is contacts page which to help students understand more, if advance knowledge and information regarding asthma or asthma research or any related events or activities is needed, we have provided them with the contacts to societies related to asthma which are the Malaysia Thoracic Society (MTS) and the Malaysia Society of Allergy and Immunology (MSAI),
The data collection was carried out from April 2015 until September 2016 in the selected schools. We collected data for both groups separately to avoid contamination of data. The sample were randomly divided two groups: Experimental group and Control group. The control group will have met for session delivered one time take one session of face to face lecture about the asthma and they will take hand workbook will be designed to be colorful, entertaining, educational, and developmentally appropriate as well as diverse in regard to gender, race, and culture. The content of the workbook includes anatomy and physiology of the lungs, management, and prevention of disease. The experimental group they received firstly face to face classroom learning for 1 hour. Flowing the face to face learning mobile app-based learning was administer for 2 months which was electronic alternative for hand workbook tool, the frequency and duration of use of the mobile application it will be flexible and according to user prefer to use it for 3 months.
Data were analyzed using Social Package Statistical Software (SPSS) version 22. Descriptive and inferential statistics were used to summarize the demographics of the school children and their level of HRQoL. Quantitative data included the calculation of mean and standard deviation. The associations between categories were determined using the Chi-squared test and the pretest and posttest to analyses the difference mean was used Split-plot ANOVA. The statistically significant is fixed at p < 0.05.