Hello, my name is Clara Caldeira
and I'm presenting the paper
A State-Based Medication Routine Framework
This work is co-authored with Pallabi
Bhowmick, Priya Komarlingam
And Katie Siek.
In this research, we looked
at medication management and
the practices that sustain or
possibly limit successful adherence.
According to the WHO,
improving adherence will lead to
very substantial benefits to
health outcomes on a population level.
In the US alone, about half of
the population takes
prescription medications.
And non-adherence or missing
medications is a cause for 30% of
hospital admissions and
over a 100 thousand
preventable deaths per year.
Research on interventions and tools to
support adherence have shown mixed results.
when there has been improvement
it is quite limited
and the most successful interventions
are very costly and difficult to scale
involving several elements such as
patient education and one-on-one counseling.
HCI researchers have argued for
designing to support
medication management strategies.
that work, the main
one being medication routines
However, we also know that routine
disruptions are a main cause for forgetfulness,
so we can't really rely on them.
So in this project
we're looking to understand people's
lived experiences with medication management
and routine disruptions
So we conducted an interview study
with 22 participants.
The criteria to participate were
taking prescribed medication at least once per
day and forgetting to take medications
at least twice per month on average
other than that,
the participants were quite diverse
their ages ranged
from mid-twenties to mid-seventies.
Their health status and medications
were pretty diverse as well
And they came from a wide range
of socioeconomic status.
In the interviews we discussed
their medication management strategies and
the reasons or situations that lead them to
forget to take their medications.
before going over the findings,
I want to talk about medication routines 63
medication routines consists of linking
the act of taking medications with a habit
that typically occurs every day.
for example, taking medications with
breakfast, before bedtime and so on.
these habits can occur at
a specific location and time,
although they can vary from day to day.
So having breakfast in the kitchen
between 7:30 and 8 in the morning.
The routines are a pretty common strategy
and most of the participants had them.
And they described how
the activity associated with
the routine itself is
a reminder for taking medication
so for example,
breakfast might include making coffee,
preparing an omelet, and
taking the vacations
We also observed that visual cues are
common strategies used
alongside the medication routines
and people place their medication
somewhere that's visible when
they're doing that activity.
for example, in the same cabinet
as the box of cereal
or next to the coffee grounds
so let's look at
an example of what this looks like.
Here we have the daily activities
of a person, from waking
up in the morning to going to bed at night.
in the second row here
we have commuting to and from work.
and in the upper right corner
is having breakfast in the morning.
This is the habit that's
linked with taking medications.
This is what the pill
bottle icon is indicating.
The person will remember to take
their medications most of the time
because they are following this
routine and they are pretty used to it.
However, before they get to that point,
there is a period of adjustment.
So say, this person gets prescribed
a new medication in the afternoon 114
a new medication in the afternoon
So they decide to take it in the office.
But until the routine is established,
there will be more likely to forget in
comparison with taking
the morning medication.
And they might use
additional strategies to remember,
such as a timed reminder.
This kind of alarm serves as
a backup if they don't remember
to take the medication without it.
In the case of the morning medication
where there is
an established routine already,
the reminder is not really needed.
It's not helpful either.
The person will remember to
take it most of the time.
And if they don't, there's not
a fixed time of the day
when they have breakfast.
So the alarm might ring when they're doing
something else before or after breakfast.
Such as taking a shower.
Most of the time when they
do forget a medication.
That's because there has been
a disruption in their routine.
For example, instead of
having breakfast at home,
as shown here in the top right,
they do something different.
So for instance,
maybe they have breakfast
with friends at a coffee shop.
In this case, is the routine that they rely
on does not occur as usual.
The activity of having
breakfast is different enough from
what happens most days
that it does not really work as a reminder.
Timed reminders also did
not really work in this case.
when the routine is disrupted,
the person often is not
home or they don't
have the medications with them,
or they're just in a hurry.
So they're likely to
forget to take their medication.
Here we have a person
who normally has a routine,
but it gets disrupted every once in a while.
And this was the most common situation
the elected forgetting
among the participants.
But we also found that sometimes people are
not able to establish
a long-term routine at all.
So they had to manage
their medications in the long-term
without a routine
this is kind of what it looked like.
The lack of medication routine
was usually due to
having daily habits that
changed a lot from day to day.
So they couldn't really
stick to a routine long
enough for it to become
part of their daily habits.
And the other strategies for
remembering also did not work well.
There was not a specific place
for them to keep
their medications that would
work as a visual cue.
And there is no ideal time
in a day for time-based reminder.
People tried to use them,
but the remainder were
ring while they were in
a meeting or driving and so on.
This is the last of four contexts or
states that influence medication management.
we organized them in this framework,
in two dimensions
Routine and non-routine
and short-term and long-term.
So here, the wellness state
is routine long-term
we called it wellness state 208
we called it wellness state
because it's kind of the ideal,
people tend to remember
their medications and they
have multiple successful strategies.
For the new task state,
they tended to use timed reminders.
But there were no successful strategies
for either of those non-routine states
The disruption state was
the most common cause of
forgetting among the participants,
since most of them were
normally in a wellness state.
However, people in
the erratic state consistently
faced the most challenges forgetting to
take their medications the most often.
This state was usually caused by
the person's occupations such
as not having the 230
as not having the
same work hours every day.
For example, this can be the case
for college students, gig workers,
freelancers, and people who
have one or more part-time jobs.
So one of our conclusions
is that there is a need for
designing technologies
that help people to manage
their medications in both
of these nonroutine states.
But first, we need to be able to
detect when people are in these states.
so that we know when they need
additional assistance with remembering.
we also need to be able to determine when is
the right time and
place to provide a reminder,
the person needs to be able
to take their medication.
So it should be nearby and they
should not be too busy doing something else.
It could be quite difficult to do
all of that with a single device.
So instead, we can think about
leveraging context awareness in
ubiquitous technologies
to provide just-in-time reminders. 260
we go into
a lot more detail in the paper
so I invite you to read it
and I'm happy to answer
any questions by e-mail or other channels.
I'll finish by thanking my co-authors
and the NSF and
the CIFellows program for supporting this work.
Thank you also for watching. 270