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Senior-centered design for mobile medication adherence applications based on cognitive and technology attributes

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Abstract

This paper aims to promote technology usage among older Saudi people by addressing the common problems they encounter around adhering to medication schedules and using mobile health applications. An interactive mobile user interface has been designed based on requirements determined using three inputs: (1) relevant existing research work, (2) interviews with medicine specialists, and (3) a survey of 602 older Saudis. The output from the first input is a set of updated guidelines adapted to the older Saudi population and reconstructed based on cognitive process attributes. The interview output identifies medication adherence issues and proposed solutions. The survey output produced a mobile technology model for older Saudis. The guidelines have been applied to a prototype and then tested in two phases: (1) pilot testing and (2) usability testing. In the testing phase, 50 older Saudi users provided insights into the effectiveness, error safety, and productivity factors of the solution developed, with the results confirming that designing mobile applications based on the model of older users and cognitive attributes improved effectiveness and reduced errors when performing mobile tasks, specifically around adherence to medications. For the productivity factor, the results align with the physical characteristics of the targeted older individuals, who typically require more time than younger people to perform certain tasks.

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Acknowledgements

The authors would like to thank all participants for contributing their time to this study.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Computer Science Department, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia

    Reem Alnanih, Amal Balabid & Lina Bahmdean

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  1. Reem Alnanih
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  2. Amal Balabid
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  3. Lina Bahmdean
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All authors contributed to the study conception and design, material preparation, and data collection and analysis. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Reem Alnanih.

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Appendices

Appendix A: Description of applied guidelines

Guideline

Cognitive attribute guidelines

Attention

G1.1

Content-oriented navigation is used in the form of a grid menu (based on preference P3.1) for the medication screen. However, a navigation bar (which supports G1.3) is implemented for the caregiver and independent screens, because these users are expected to have more advanced technical expertise

G1.2

All the options on the “add medication” screen are visible to the user

G1.6

The use of scrolling was avoided on all screens to the extent possible. For example, on the “add medication” screen, the entries are divided into two screens and separated by the “Next” button to avoid scrolling. Scrolling is only used if the number of medications increases

G1.7

On the “medication follow-up” screen, a back-to-top button has been added to enable the user to instantly jump to the screen’s home position

G1.9

Consistency was considered for all of the application’s visual elements:

- Font (Proxima Nova and Arial)

- Color (three colors were used)

- Size (standardized)

- Style of icons and menus

G1.10

The application does not contain ads and uses a plain background to avoid distractions

G1.11

Pop-up windows are never used, with designers replacing them with other design items

G1.12

The movement of opening the pillbox is not simulated to avoid animation

G1.13

Different information is categorized using different colors on the medication screen:

- Red for expired medications

- Green for full medications

- Gray for medications that are nearly empty

Perception and recognition

G2.1

Simple and descriptive language has been used to make it easier for older people to understand. For example, “Identify medication” instead of “Identify,” “Edit profile” instead of “Edit,” and “Add medication” instead of “Add.”

G2.2, G5.4, G6.1

There are options on user screens to control volume and vibration

G2.3

Arabic numerals were used for all application screens

G2.4

Mandatory fields are marked with a red asterisk, and the entire entry header is marked with red in case the user has not filled it in

G2.5

Continuous and consistent feedback is provided in all application screens:

- Confirmation operations messages, such as confirming the addition of an older person (readable feedback);

- Changing the color of a button to green after users confirm that they have taken a medication (visual feedback);

- Reading the name of a medication when pressed (audio feedback)

G2.6

When entering information, the cursor that appears inside the field in green

G2.8

Confirmation messages are shown to the user after completing any task, such as registering or adding medication, and before critical operations, such as deleting medications

G2.9

Entries are minimized to the extent possible. An SFDA database has been employed to support the entry process

G2.11

The color contrast has been considered in developing the application’s screens, leading to difference ratios between the backgrounds and text ranging from 4.95 to 13.74, achieving AAA or AA level, according to WCAG 2.0 [60] [61]

G2.16

Inside the pillbox, the user can hear the name of any medicine by pressing it

G2.17

The essential buttons are provided at the top of the screen. These include the “Identify Medication” and “Add Medication” buttons

G2.19

According to this guideline and the questionnaire results, which emphasize older people’s abilities to distinguish between active and disabled buttons, user options (inside the pillbox) are restricted as follows:

- The week’s days are disabled except for the current day

- The process of confirming having taken the medication is disabled if it is the wrong time

- The current day appears in a different color

Memory

G3.1

The bar at the bottom of the screen allows the user to know their current location, because the current screen icon appears in a different color

G3.2

All screens have titles (e.g., Medication, Notifications, and Daily Report)

G3.3

Navigation and steps have been reduced in all screens. For example, on the pillbox screen, the user can perform many tasks (such as confirming taking the medication, checking the medication, and hearing the name of the medication) on one screen

G3.4

The amount of information required to complete the registration process has been reduced. It is limited to name, age, mobile phone number, and caregiver’s password and name

G3.5

Medications are divided and grouped according to time of day

G3.6

The automatic entry feature has been implemented in the form of using the QR code on the “Add Medication” screen and using the QR code to link the older person’s account with the caregiver’s account without needing to enter the user ID

G3.7 and G4.3

The pillbox has been used as a metaphor to generate an idea about how to interact with the application screens, because older people are familiar with pillboxes

G4.1

A medication confirmation feature has been added that uses the camera. This is an existing feature of the WhatsApp application, and WhatsApp is a familiar application for older people

G4.4

The undo feature is provided for some operations. For example, if users accidentally confirm that they have taken a medication, they can undo it

G4.5 and G4.6

The registration process for older users is facilitated by enabling the process’s completion by solely scanning the caregiver’s QR code. Additionally, tutorials have been added to support and facilitate the use of the application

Reading, speaking, and listening

G5.3

The actions used to operate the application have been minimized, with all application screens depending on two types of actions (click and drag)

G5.6

Proxima Nova (a sans-serif font) is used for all English- and French-language screens, with Arial used for all Arabic-language screens

Problem-solving, planning, reasoning, and decision-making

G6.2

Hierarchical levels have been minimized, with less information required at lower levels. However, note the following:

- On the “Add Medication” and login screens, three hierarchical levels are used

- On the pillbox screen, two hierarchical levels are used

Appendix B: Description of applied preferences

Preference

Cognitive attribute preferences

Notes

Attention

P1.1

Application views are based on the user’s color preferences (blue, turquoise, or pink), and the choice of these three color tones is based on the need for high contrast, fulfilling G2.11

Older people prefer blue and pink for fonts and blue and turquoise for backgrounds

Perception

P2.1

The days of the week are designed inside the pillbox, starting with Sunday

60.5% of older people consider the start of the week to be on Sunday

P2.2

Redundant (i.e., text with icon) interfaces have been used

 

*Solves the contradiction between G2.12 and G2.13

95.3% of older people prefer redundant interfaces, with 4.7% preferring word-based interfaces

 

Memory

P3.1

Grid menus have been used instead of vertical menus

 

*Resolves the contradiction between G3.8 and G3.9

85.9% of older people prefer a grid menu over a vertical menu

 

Learning

P4.1

A rectangular rather than a circular shape has been adopted for the pillbox

80.9% of older people prefer the rectangular shape

Reading, speaking, and listening

P5.1

An 18-point font size has been adopted as the smallest font used in the application

Font sizes suggested in previous studies varied from 12 to 18 pt. According to the data collected, 90.7% of older users prefer a font size of 18 pt. Therefore, this font size has been adopted as the smallest font

P5.2

A family member’s voice is used to deliver reminder messages

*Resolves the contradiction between G5.8 and G5.9

One study suggested using male voices [38], and another study suggested using a voice of the same sex as the user [32]. However, following this paper’s suggestion of using a family member’s voice, as expected, 55.8% of older people preferred this approach

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Alnanih, R., Balabid, A. & Bahmdean, L. Senior-centered design for mobile medication adherence applications based on cognitive and technology attributes. Univ Access Inf Soc (2023). https://doi.org/10.1007/s10209-023-00979-y

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