Approximately 6 million US children have asthma, and between school and home, they spend 80%-90% of the day indoors [1]. There is evidence that indoor air exposure significantly affects asthma severity. Studies emphasize that the indoor environment and housing quality are crucial determinants of asthma outcomes, yet self-reported assessments are subject to recall bias and misclassification of exposures [2]. The emergence of digital indoor air quality monitors offers a possible scalable and sustainable approach to indoor air data collection that could aid in tailored recommendations for the home environment [3,4]. However, studies utilizing these monitors are still limited in clinical care, and concerns remain about equitable deployment of these tools [3]. The aims of this study are (1) to assess the feasibility and acceptability of using digital in-home air quality monitors in the homes of children with asthma and (2) evaluate the feasibility of providing a WiFi hotspot to overcome internet connectivity barriers.

The study sample was mostly composed of mothers (n=17, 85%), those living in an apartment/duplex (n=13, 65%), and those with a high school diploma or less (n=12, 60%) (Table 1). Baseline digital health literacy and asthma management self-efficacy were high.

This study demonstrated that data collection with digital indoor air quality was feasible and acceptable to a socioeconomically varied sample of families with children with asthma.

The high feasibility may be due to the pre-pairing of monitors with WiFi hotspots so that participants only had to plug in each device at home with no additional set-up. The air monitor intervention’s usability score, despite scoring similarly to other air pollution monitors (SUS: 50-66), fell slightly below the threshold for acceptable usability, suggesting further inquiry is needed to understand how usability can be improved. Nevertheless, this rating was similar to how the public rated using cellphones in past evaluations (SUS: 66.5) [8]. Nevertheless, over a quarter of participants were unsure if they would have joined without the WiFi hotspot. Proponents of health equity have highlighted that neighborhood broadband access and perceived digital self-efficacy can limit access and use of digital health tools [9].

For acceptability, most participants reported a future interest in using a digital air monitor if provided by the clinic, and the data reviewed with the pediatric allergist were well-received. This finding fits with those from other digital health studies, that is, that closed-loop communication by the health care team about patient-generated health data is crucial to enhance chronic disease self-management [10]. However, this study’s aggregated data report, short enrollment period, and device limitations prohibited more tailored recommendations for improving asthma control.

Despite interest in the monitors, half of the participants also identified that they could not afford the cost of the monitor themselves. A recent Centers for Medicare & Medicaid Services (CMS) policy will address this cost barrier to digital health adoption by reimbursing technology-supported health care, including wearable devices and health coaching apps, for Medicare-insured patients with certain chronic conditions [11]. While this CMS model may alleviate costs for some, this will not address affordability for pediatric populations, and expanded access models for technology-supported pediatric health care should be considered.

Study limitations included (1) participants’ lack of real-time air quality data during the study, which affected their ability to make at-home modifications, (2) the inability of this type of air monitor to detect indoor environmental allergens (eg, mold, dander), and (3) the short enrollment period and small sample size, which limited inferences about sustained engagement with the air monitors and impact on asthma control, respectively.

Though the feasibility and acceptability of the digital air quality monitoring intervention were promising in this study, affordability was highlighted by participants as a key barrier to the use of these tools in clinical care. Future studies should also incorporate real-time feedback and associated clinical management with air quality monitoring year-round.