Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial

Ernesto Zárate-Bravo, Juan-Pablo García-Vázquez, Engracia Torres-Cervantes, Gisela Ponce, Ángel G Andrade, Maribel Valenzuela-Beltrán, Marcela D Rodríguez, Ernesto Zárate-Bravo, Juan-Pablo García-Vázquez, Engracia Torres-Cervantes, Gisela Ponce, Ángel G Andrade, Maribel Valenzuela-Beltrán, Marcela D Rodríguez

Abstract

Background: Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users' attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence.

Objective: This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults.

Methods: A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique.

Results: The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD's external cues not only improved older adults' medication adherence but also mediated family caregivers' involvement.

Conclusions: The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior.

Trial registration: ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97.

Keywords: aged; family caregiver; health information systems; medication adherence.

Conflict of interest statement

Conflicts of Interest: None declared.

©Ernesto D. Zárate-Bravo, Juan-Pablo García-Vázquez, Engracia Torres-Cervantes, Gisela Ponce, Ángel G Andrade, Maribel Valenzuela-Beltrán, Marcela D Rodríguez. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 02.03.2020.

Figures

Figure 1
Figure 1
Study activities and instruments administered to participants during each study phase. CG: control group; MAQ-8: 8-item Medication Adherence Questionnaire; MedMaIDE: Medication Management Instrument for Deficiencies in the Elderly; SPMSQ: Short Portable Mental Status Questionnaire; TG: treatment group.
Figure 2
Figure 2
A research assistant arranging medications in a basket.
Figure 3
Figure 3
Abstract representations of medication adherence based on parakeet growth.
Figure 4
Figure 4
Detailed information about the medication adherence corresponding to the current day and notation used to represent if medicines were taken on time.
Figure 5
Figure 5
Medication Ambient Display reminding to medicate.
Figure 6
Figure 6
Registering the medication: After a senior medicates, she/he should move the corresponding medication container closer to the tablet in order for the attached NFC tag can be recognized by the tablet NFC reader (left); then, MAD acknowledges that the medicine was registered as taken on time (right).
Figure 7
Figure 7
User interfaces of the administration component of Medication Ambient Display, which shows how it enabled the information registration of each medication.
Figure 8
Figure 8
Flow diagram of the participants’ progress through the study phases. CG: control group; MCI: mild cognitive impairment; TG: treatment group.

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