In the United States, 3.8 billion prescriptions are written annually. Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration (Neiman et al., 2017). Whereas rates of non adherence across the United States have remained relatively stable, direct health care costs associated with non adherence have grown to approximately $100–$300 billion of U.S. health care dollars spent annually (Neiman et al.). Not taking medication places patients at a 5.4 times increased risk of hospitalization, re-hospitalization, or premature death (Neiman et al.). The challenge is how to best know when there is a medication adherence problem. The purpose of this study was to test the usability of a smart medication device and its alert system.
Our research team developed a smart medication device called, Every Med Every Time (E.M.E.TTM). The E.M.E.TTM has 28 bins (7 days at 4 times per day) to hold a week’s worth of medications. Each device has have an integrated touchscreen, cellular connectivity, and camera over each bin. The integrated camera is used to image each medication bin for the amount of medications and report variations to a family member or health care provider. Before the product was developed, we planned usability testing to keep the end-users engaged in the early design stages because too often end-users are the last thought (Frith, 2018). Technology can be developed by anyone with a little knowledge of coding and no knowledge of user design principles; however, these new devices or apps can be seriously flawed (Wright et al., 2018). For example, Georgsson and Staggers (2016) investigated the usability of a diabetes app and found nearly 120 problems, which they coded into 19 usability categories. Devices that are difficult to use can also create harm if used improperly (Frith, 2019). Thus, we knew that usability testing was necessary to create a device that was easy to use by older adults in their homes.
Methods:
We followed usability study guidelines outlined by the US Department of Health & Human Services (2018) in our usability testing on the device and its alert system. The research design was descriptive; participants interacted with the new device and answered questions on a 10-items System Usability Scale (SUS) to measure the ease of use and the usefulness of the device and alert system (Brooks, 1986). Participants were asked to provide suggestions for improvement of the device and its alert system.
We recruited 45 older adults from a local geriatric medical practice and from a university’s Osher Lifelong Learning Institute to participate in the usability study. We used convenience sampling for the usability study. The participants were diverse in terms of race and ethnicity: 78% were white, 16% were African American, 4% were Asian American, and 2% were Hispanic. Of the initial 45 participants, 37 completed the entire usability study.
The setting for the usability study was a laboratory in the College of Nursing. We had private rooms for participants to interact with the device and alert system. We held two user meetings: July 2018 and October 2018. The participants were given scenarios so they would manipulate the devices and alert system. After their session, they completed the SUS and were interviewed to ask for suggestions to improve the device.
Results:
Results from the first user meeting showed the device and software alert system were usable with the scores being 71.6% and 70.6%, respectively (a score of 68% is deemed usable). We used verbal and written suggestions to further improve the device and alert system. In the second user meeting, held on October 2018, we presented the changes that were made and invited participants to interact with the device and alert system again. Scores on the SUS increased to 86% for the device and alert system.
Based on the results of the second user meeting, our research team will continue the research and development of the smart medication organizer for use in field testing with the aim to reduce non-adherence among individuals with chronic conditions including hypertension and diabetes.
Conclusion:
Failure to attend to usability can frustrate end-users or cause harm. The responsibility for ensuring health information technology to change health behaviors produce an outstanding user experience rests with nurse scientists and the teams they create. Nurse scientists who plan to seek funding for research and development of health information technology must conduct usability studies prior to field testing if they wish to obtain federal funding or obtain Federal Drug Administration (FDA) clearance.