All Projects

MAX: A Digital Health Literacy Coach for Children with Asthma

Health literacy is a crucial ingredient of successful asthma self-management. Studies have shown that a lack of asthma health literacy leads to lower levels of asthma control and thus more severe asthma symptoms, which, in turn, results in a suboptimal course of the disease. However, due to limited personnel and financial resources of healthcare systems, communication of health literacy during on-site consultations does not scale into the everyday life of patients where they need to apply the health literacy knowledge. Ubiquitous technology has the potential to extend the reach of health professionals to the daily life of individuals and could be thus, also a promising channel to bring health literacy content to patients. Nevertheless, it is still open, how such a digital health literacy program must be designed to reach and positively impact a maximum of individuals affected by asthma. This research project has two objectives:

  1. to assess the reach and technical feasibility of a novel mobile coach MAX for children with asthma and, in supporting roles, their family members and healthcare practitioners and
  2. to assess the impact of MAX on children’s health literacy in dealing with asthma.

To reach these goals, we apply the multiphase optimization strategy (MOST) and start with a pilot study (the preparation phase) before follow-up micro-randomized trials, and finally, a fully-powered randomized controlled trial is planned.

Study website:

Interaction with MAX

Inhalation video recording of Norah, 12

The health literacy video clips

Eleven health literacy video clips for children with asthma have been produced in German, French and Italian language versions. These video clips can be watched online and are also part of the mobile health literacy intervention MAX.

11 Health literacy video clips for children with asthma


This project received the following awards:

  1. The 11 video health literacy video clips for children with Asthma entitled “Asthma kindgerecht erklärt” received the Intermedia-globe Gold Award 2018 in the category E-Learning and Education (Web) at the World Media Festival 2018 in Hamburg, Germany.
  2. The mobile MAX intervention for children with Asthma entitled “MAX – Dein Asthmacoach” received the Intermedia-globe Gold Award 2019 in the category Mobile Apps & Interactive Tools at the World Media Festival 2019 in Hamburg, Germany.
  3. The mobile MAX intervention for children with Asthma entitled “MAX – Dein Asthmacoach” received the Intermedia-globe Grand Award 2019 in the category Web at the World Media Festival 2019 in Hamburg, Germany.


Kowatsch, T., Harperink, S., Dittler, U., Xiao, G., Stanger, C., Oswald, H., Möller, A. (2019) A digital assistant for healthcare providers targeting 10 to 15-year-old patients with asthma and their family: results from a pilot study, Abstract published by the Center for Digital Health Interventions, ETH Zurich & University of St.Gallen. (PDF)

Kowatsch, T., Fischer-Taeschler, D., Putzing, F., Bürki, P., Stettler, C., Chiesa-Tanner, G., Fleisch, E. (2019) Die digitale Pille für chronische Krankheiten, in: Digitale Transformation von Dienstleistungen im Gesundheitswesen VI – Impulse für die Forschung, M. Pfannstiel, P. Da-Cruz and H. Mehlich (eds.), Springer Gabler, Heidelberg, Germany, 205-231. (PDF)

Kowatsch, T., Barata, F., Tinschert, P., Dittler, U., Egger, J.M., Meyer, F., Schaub, M., Fleisch, E., Oswald, H., Möller, A. (2017) Digital Health Literacy Intervention for Children with Asthma, Poster presented at the CSS Health Insurance meets CDHI Event, Lucerne, Switzerland. (Poster-PDF)

Möller, A., Oswald, H, Dittler, U., Meyer, F., Schaub, M., Barata, F., Tinschert, P., Egger, J.M., Fleisch, F., Kowatsch, T. (2017) Health Literacy Video Clips for Children with Asthma, Poster presented at the CSS Health Insurance meets CDHI Event, Lucerne, Switzerland. (Poster-PDF)

Related Work

Kowatsch, T., M. K. Nißen, D. Rüegger, M. Stieger, C. Flückiger, M. Allemand and F. von Wangenheim (2018) The Impact of Interpersonal Closeness Cues in Text-based Healthcare Chatbots on Attachment Bond and the Desire to Continue Interacting: An Experimental Design, 26th European Conference on Information Systems (ECIS 2018), Portsmouth, UK. (PDF)

Kowatsch, T., Volland, D., Shih, I., Rüegger, D., Künzler, F., Barata, F., Filler, A., Büchter, D., Brogle, B., Heldt, K., Gindrat, P., Farpour-Lambert, N., l’Allemand, D. (2017) Design and Evaluation of a Mobile Chat App for the Open Source Behavioral Health Intervention Platform MobileCoach, In: Maedche A., vom Brocke J., Hevner A. (eds) Designing the Digital Transformation. DESRIST 2017. Lecture Notes in Computer Science, vol 10243. Springer: Berlin; Germany, 485-489. (Paper-PDF | Poster-PDF | Slide-PDF | Screencast)

Filler, A., Kowatsch, T., Haug, S., Wahle, F., Staake, T. & Fleisch, E. (2015) MobileCoach: A Novel Open Source Platform for the Design of Evidence-based, Scalable and Low-Cost Behavioral Health Interventions – Overview and Preliminary Evaluation in the Public Health Context. Wireless Telecommunications Symposium 2015 (WTS 2015), New York, USA. *** Outstanding Paper Award & Best Graduate Student Paper Award*** (PDF)

CDHI Research Team

Samira Harperink, Peter Tinschert, Filipe Barata, Matthias Heuberger, Prof. Dr. Elgar Fleisch & Prof. Dr. Tobias Kowatsch


Jan 2017 – June 2020


Prof. Dr. med. Alexander Möller (Children’s Hospital Zurich), Dr. med. Helmut Oswald (Cantonal Hospital Winterthur), Dr. med. Peter Salfeld (Cantonal Hospital Thurgau), Dr. med. Reto Villiger (Hospital Biel), Dr. med. Linn Krüger (University Hospital Bern), Grace Xiao (Harvard University), Nathalie Gasser, Valérie Rohrer, Philippe Giroud, Jean Marie Egger (Lung League Bern), Corinne Kappeler & Hugo Bossi (Lung League Thurgau), Dominique Mordelet, Judith Ruoss & Urs Brütsch (Lung League Bern), Dirk Volland & Andreas Filler (Pathmate Technologies)

CSS Insurance