Matthew L. Lee
Anind K. Dey
ABSTRACT
Medication taking is a self-regulatory process that requires individuals to self-monitor their medication taking behaviors, but this can be difficult because medication taking is such a mundane, unremarkable behavior. Ubiquitous sensing systems have the potential to sense everyday behaviors and provide the objective feedback necessary for self-regulation of medication taking. We describe an unobtrusive sensing system consisting of a sensor-augmented pillbox and an ambient display that provides near real-time visual feedback about how well medications are being taken. In contrast to other systems that focus on reminding before medication taking, our approach uses feedback after medication taking to allow the individual to develop their own routines through self-regulation. We evaluated this system in the homes of older adults in a 10-month deployment. Feedback helped improve the consistency of medication-taking behaviors as well as increased ratings of self-efficacy. However, the improved performance did not persist after the feedback display was removed, because individuals had integrated the feedback display into their routines to support their self-awareness, identify mistakes, guide the timing of medication taking, and provide a sense of security that they are taking their medications well. Finally, we reflect on design considerations for feedback systems to support the process of self-regulation of everyday behaviors.
- Bandura, A. Self-efficacy: toward a unifying theory of behavioral change. Psychological review 84, 2 (1977), 191.Google Scholar
- Bandura, A. Social cognitive theory of self-regulation. Organizational behavior and human decision processes 50, 2 (1991), 248--287.Google Scholar
- Brus, H., Van de Laar, M., Taal, E., Rasker, J., and Wiegman, O. Determinants of compliance with medication in patients with rheumatoid arthritis. Patient Education and Counseling 36, 1 (1999), 57--64.Google ScholarCross Ref
- Consolvo, S., Klasnja, P., McDonald, D. W., et al. Flowers or a robot army' encouraging awareness & activity with personal, mobile displays. In Proc. Ubicomp 2008, ACM (2008), 54--63. Google ScholarDigital Library
- Consolvo, S., McDonald, D. W., and Landay, J. A. Theory-driven design strategies for technologies that support behavior change in everyday life. In Proc. CHI 2009, ACM (2009), 405--414. Google ScholarDigital Library
- Elliott, R. A. Problems with medication use in the elderly: an Australian perspective. Journal of Pharmacy Practice and Research 36, 1 (2006), 58.Google ScholarCross Ref
- Erickson, T., et al. The dubuque water portal: evaluation of the uptake, use and impact of residential water consumption feedback. In Proc CHI 2012, ACM (2012), 675--684. Google ScholarDigital Library
- Fishkin, K. P., Wang, M., and Borriello, G. A ubiquitous system for medication monitoring. In Proc. Pervasive 2004.Google Scholar
- Friedman, R. H., et al. A Telecommunications System for Monitoring and Counseling Patients With Hypertension. Am J Hypertension 9, 4 (1996), 285--292.Google ScholarCross Ref
- Gadkari, A. S. and McHorney, C. A. Unintentional non-adherence to chronic prescription medications. BMC Health Services Research 12, 1 (2012), 98.Google ScholarCross Ref
- Hayes, T. L., Cobbinah, K., Dishongh, T., et al. A study of medication-taking and unobtrusive, intelligent reminding. Telemedicine and e-Health 15, 8 (2009), 770--776.Google Scholar
- Haynes, R. B., Ackloo, E., Sahota, N., McDonald, H. P., & Yao, X. Interventions for enhancing medication adherence. Cochrane database syst Rev, 2, 2 (2008), 11.Google Scholar
- Kripalani, S. Interventions to Enhance Medication Adherence in Chronic Medical Conditions. Archives of Internal Medicine 167, 6 (2007), 540.Google ScholarCross Ref
- Lee, M. L. and Dey, A. K. Reflecting on pills and phone use: supporting awareness of functional abilities for older adults. In Proc. CHI 2011, ACM (2011), 2095--2104. Google ScholarDigital Library
- Li, I. Personal informatics & context: Using context to reveal factors that affect behavior. J. Ambient Intell. Smart Environ. 4, 1 (2012), 71--72. Google ScholarDigital Library
- Locke, E. A. and Latham, G. P. A theory of goal setting & task performance. Prentice-Hall, Inc, 1990.Google Scholar
- Lundell, J. et al., Continuous activity monitoring and intelligent contextual prompting to improve medication adherence. In Proc. EMBS, IEEE (2007), pp. 6286--6289.Google Scholar
- Maes, S. and Karoly, P. Self-Regulation Assessment and Intervention in Physical Health and Illness: A Review. Applied Psychology 54, 2 (2005), 267--299.Google ScholarCross Ref
- McDonnell, P. J. and Jacobs, M. R. Hospital admissions resulting from preventable adverse drug reactions. The Annals of pharmacotherapy 36, 9 (2002), 1331--1336.Google Scholar
- McGee-Lennon, M. R., Wolters, M. K., and Brewster, S. User-centred multimodal reminders for assistive living. In Proc. CHI 2011, ACM (2011), 2105--2114. Google ScholarDigital Library
- Morris, S. B. Estimating effect sizes from pretest-posttest-control group designs. Organizational Research Methods, 11, 2, (2008), 364--386.Google ScholarCross Ref
- Nelson, R. O. and Hayes, S. C. Theoretical Explanations for Reactivity in Self-Monitoring. Behavior Modification 5, 1 (1981), 3--14.Google Scholar
- De Oliveira, R., Cherubini, M., and Oliver, N. MoviPill: improving medication compliance for elders using a mobile persuasive social game. In Proc. Ubicomp 2010. ACM (2010), 251--260. Google ScholarDigital Library
- Risser, J., Jacobson, T. A., and Kripalani, S. Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease. Journal of nursing measurement 15, 3 (2007), 203--219.Google Scholar
- Rogers, Y., Hazlewood, W. R., Marshall, P., Dalton, N., and Hertrich, S. Ambient influence: can twinkly lights lure and abstract representations trigger behavioral change' In Proc. Ubicomp 2010, ACM (2010), 261--270. Google ScholarDigital Library
- Williams, G., Rodin, G., Ryan, R., Grolnick, W. and Deci, E. Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychology, 17, 3 (1998), 269.Google ScholarCross Ref
- Zhu, L. L., Zhou, Q., Yan, X. F., Zeng, S. Optimal time to take once-daily oral medications in clinical practice. International Journal of Clinical Practice, 62 (2008), 1560.Google ScholarCross Ref
- http://www.vitality.net/glowcaps.html.Google Scholar
- http://proteusdigitalhealth.com/.Google Scholar
Index Terms
- Real-time feedback for improving medication taking
Recommendations
A personalized medication management platform (PMMP) to improve medication adherence
Addressed medication non-adherence, an important aspect in healthcare which significantly influences patients health and expenses to patients, healthcare providers and insurance companies.The PMMP platform implemented and tested through a randomized ...
An Activity Recognition System for Taking Medicine Using In-The-Wild Data to Promote Medication Adherence
IUI '21: Proceedings of the 26th International Conference on Intelligent User InterfacesNearly half of people prescribed medication to treat chronic or short-term conditions do not take their medicine as prescribed. This leads to worse treatment outcomes, higher hospital admission rates, increased healthcare costs, and increased morbidity ...
Sensor-based observations of daily living for aging in place
Older adults often find it difficult to keep track of their cognitive and functional abilities required for remaining independent in their homes. Healthcare providers need objective, timely, and ecologically valid information about their patient's ...
Reviews
Amos O Olagunju
Elderly patients with multiple lingering medical conditions habitually take several pills every day. How should effective real-time feedback sensor display systems be designed for patients who take many drugs at specific times each day__?__ In an effort to address absentmindedness, negligence, and/or the fear of troublesome side effects, Lee and Dey built a sensor-augmented pillbox for monitoring medicine use behaviors of patients. The seven-day pillbox consists of an accelerometer to trace when it is picked up, spring switches to discover open pillbox doors, and a conventional circuitry with microcontrollers and a wireless modem. The pillbox sensor uses a wireless network to transmit data captured from each patient to a remote server. The server processes the patient behavioral data to ascertain and assess the incidents of medicine consumption, and to provide visual feedback display on how well individual patients take medications, use the phone, and prepare coffee. A focus group experiment was performed to investigate the effective use of a feedback display in helping patients accurately take medicine. Twelve elderly patients with multiple protracted illnesses such as hypertension and diabetes were randomly assigned to feedback and control groups. The feedback group patients viewed the performance of their medication-taking behaviors in real time from a tablet display, whereas the control group patients only received a hard copy performance report for one month. The authors evaluated the impact of a real-time feedback display on medication-taking behaviors. Adherence is the percentage of all pills taken in a time period. Correctness is the rate of accurate pills taken each day. Promptness is the percentage of pills taken on time. Time of day variance "measures how the time of day that medications were taken varied from one day to another." Self-efficacy is the extent to which patients feel confident about surmounting the barriers to taking medications. The feedback display significantly enriched adherence, promptness, correctness, and the variance in the time of day; it had no significant effect on self-efficacy. Although the small number of patients studied limits the generalizability of the experimental results, the authors have developed a valuable tool for monitoring the drug intake behaviors of patients with multiple chronic health problems. Online Computing Reviews Service
Access critical reviews of Computing literature here
Become a reviewer for Computing Reviews.
Comments