126 Chapter 5 5 Secondary outcomes Asthma control Asthma control is measured with the ACQ-5 (35). The ACQ-5 is developed as a selfreport measure to assess asthma control. The five items of the ACQ are each rated on a 7-point scale (0 - 6 points). The items assess sleep deprivation, symptoms on waking, activity impairment, dyspnoea and wheezing during the previous week. Patients with a score of ≤0.75 are considered as having controlled asthma; patients with a score of ≥1.5 are considered as having uncontrolled asthma (36). A change of ≥0.5 is considered the minimal clinically important difference (MCID)(37). Asthma-related quality of life Asthma-related quality of life is assessed with the self-administered mini AsthmaRelated Quality of Life Questionnaire (Mini-AQLQ). Each of the 15 items is rated on a 7-point scale (1-7 points), and the questions cover four domains (symptoms, activities, emotions and environment)(38). A higher score indicates better asthmarelated quality of life. The MCID is considered to be 0.5 (39). Reliever use Reliever use (SABA) is electronically monitored in a subgroup of patients, who are in possession of a reliever inhaler which is compatible with an EMD. Reliever prescription data are retrieved from the patient’s pharmacy at study end for all participating patients. Exacerbations The total number of severe exacerbations is collected through self-report (interview during visits and questionnaires at T3 and T9) and through the patient’s pharmacist and general practice electronic health record system. The definition of a severe exacerbation is either the use of systemic corticosteroids or an increase from a stable inhaler maintenance dose for at least 3 days, or hospitalisation or an emergency department visit because of asthma requiring systemic corticosteroids. Acceptance and usability of the smart inhaler programme The usability and acceptance of the smart inhaler programme are assessed among patients and practices allocated to the intervention group, using two questionnaires. Acceptance is measured with the Technology Acceptance Questionnaire, which consists of 22 items (e.g., ‘using Turbu+ makes it easier to manage my asthma’ and ‘I find Turbu+ easy to use’) which are scored on a 5-point Likert-scale. The items are based on the technology acceptance model (TAM) and the Unified theory of acceptance and use of technology (UTAUT) and address the intended use and different factors determining the behavioural intention to use the smart inhaler programme (40,41). Usability is assessed using the System Usability Scale (SUS) (42). This is a generic instrument to measure usability of a technology or service and contains 10 items which are adapted to the specific technology or service. The items
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