Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 21, 2019
Date Accepted: Sep 24, 2019
Supporting the medication adherence of older Mexican adults through external cues provided with ambient displays: a feasibility study
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. Based on 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 a medication ambient display (MAD) that calls the older adults’ attention to assist them in taking their medications on time, and in providing daily awareness about how the medication regimen is followed.
Objective:
The aim of this study was to assess the adoption and effect of external cues provided through ambient displays for assisting older adults to adhere to their medications.
Methods:
Sixteen older adults participated in the study, who took at least three medications and had mild cognitive impairment. 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 post-intervention phases. Half of the participants were randomly allocated to the treatment group (TG=8) and the other half to the control group (CG=8). During the study phases, research assistants weekly measure the adherence to the medication through the pill counting technique.
Results:
The TG improved their adherence behavior from 80.9% in the baseline phase, to 95.97% in the intervention phase during which they used MAD, and finally, it decreased to 76.71% in the post-intervention due to the withdrawal of MAD. By using one-way repeated measures ANOVA and post-hoc analysis using Tukey’s HSD test, we identified a significant statistical difference between the pre-intervention and intervention phases (P=.02), and between the intervention and post-intervention phases (P=.0016). On the other hand, the TG’s medication adherence rate (95.97%) was greater than the CG (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, following by the adherence abstract representations presented daily. We also found that the peripherally of the external cues not only improved the older adults’ medication adherence but mediated the family caregivers’ involvement.
Conclusions:
Our results demonstrate that using ambient modalities for implementing external cues is useful to draw the attention of the elderly in order to remind them to take medications, and to provide immediate awareness about how they followed their medication regimens. Clinical Trial: No registration. This is a feasibility study using a mixed methods approach.
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