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Slide 2 Marcela D. Rodrguez Autonomous University of Baja California, UABC, Mexicali, Mxico marcerod@uabc.edu.mx Slide 3 Why knowledge of experts is important to consider when designing AHA? How expert knowledge can be used to abstract design principles for AHA? Slide 4 Slide 5 I. Approaches for using expert knowledge a. Systematic Reviews b. Heuristic Evaluations II. AIS for Elderly Medication III. Design Dimensions for AIS IV. Conclusions Slide 6 Essential tool for summarising evidence accurately and reliably. Collate empirical evidence that fits pre- specified eligibility criteria to answer a research question. Provides reliable findings from which conclusions can be drawn and decisions made. Slide 7 PRISMA [Liberati et al, 2009] : 27-item checklist and a four-phase flow diagram Slide 8 The researcher may look for each study and counting them as votes about the question focus. Ie., in a specific SR conducted in the field of medicine, the researcher found that, among 35 valid studies, 29 showed a positive result, while 5 showed no result, and one study showed a negative result. Internal comparison of studies, based on their specific parameters: i.e. the negative effect must be due to a different dosage scheme, while the five studies that showed no result were conducted in subjects that had a different age distribution in comparison to the 29 positive ones. Slide 9 Meta-analysis [optional]: the original individual studies are treated as if they were parts of one larger study single and final result summarizes the whole evidence. It is important to include descriptive evaluation of each study tabular format or tables including population, oucomes, evaluation, etc. This help to determine if the studies results can be pooled to a metaanalysis Slide 10 Slide 11 Formulation of a research question. Define elegibility criteria Exhaustive searching of literature Assessing the literature for elegibility Data extraction. Summary and synthesis of study results (me- ta-analysis). Interpretation of the results. Slide 12 Set of methods that are all based on having evaluators inspecting a user interface. Identify Usability Problems Inspectors evaluate the UI to check that it conforms with a set of design characteristics Inspector: domain and usability expert Non-experts: Colleague, potential users Slide 13 http://www.nngroup.com/articles/ten-usability-heuristics/ A small set of evaluators (3-5) examine the interface and judge its compliance with recognized usability principles (the heuristics) [Nielsen, 1994] Different evaluators identify different UP More evaluators, more UP Slide 14 Prepare tasks descriptions Individual Inspection Session 1-2 hour session, double revision Each inspector prepare a list of UP Analysis of Heuristic Inspection Data Integrated list of UP Interpretation of Heuristic Inspection Data Set of Design Recommendations Slide 15 Less expensive than users observation Experts tend to suggest solutions Large number of (obvious) errors are discovered before users observation Inspections complement users observation Slide 16 Rely on the inspectors ability to predict the kind of usability problems. Ideally, an inspector is expert in HCI and the domain. Make false assumptions of what actual users will do with the UI. Inspectors may have their own preferences and views toward the UI design. Slide 17 Instructor: Marcela D. Rodrguez (UABC, Mxico) marcerod@uabc.edu.mx Slide 18 Definition: taking the prescribed number of pills each day, within a prescribed period It is reported as the % of medication taken Patients with chronic conditions has a low adherence Rates of adherence drops most dramatically after 6 months of therapy Slide 19 26% to 59% of older adults have lower drugs compliance [Orwing et al, 06] Elders living alone, and taking more than 3 medicines are prone to medication errors Forgetting to take their drugs, taking incorrect doses, and to terminate drug-taking prematurely [Lison et al, 2006]. Slide 20 Elders prefer aesthetic assistive producst (Forlizzi, 2004) (Hirsch et al, 2000). Based on their abilities and necessities (Rogers & Mynatt, 2003) Use a familiar language (Fisk et al, 2003). Integrated into their ADLs Aesthetic Easy to use Easy to comprehend Integrated into the environment Integrated into the environment Assistive Technology Slide 21 Ambient Displays (Wisneski et al, 1998) Ambient Displays (Wisneski et al, 1998) AIS Notification Systems (McCrikard et al, 2001) Notification Systems (McCrikard et al, 2001) Peripherical Displays (Matthews et al, 2004) Peripherical Displays (Matthews et al, 2004) They are aesthetically pleasing applications that provide valued information through ambient changes and abstract representations, that are easy to comprehend: Slide 22 17 older adults between 65 and 86 years old, who take between 3 and 10 medicines 40-minute contextual interviews (MedMaIDE index) [Orwing 06] : What elders know about their medication The place where they medicate supporting resources they use for medicating involved community. Marcela D. Rodrguez, UABC21 Slide 23 22 Elders Strategies GoalGoal EvidenceEvidence Have a specific place to medicate Sort their medicines Write down notes indicating the medicine purpose Visit periodically to their doctors Not forget taking their medicines. Have the objects they need to medicate Avoid taking incorrect doses or medicines Remember the health problem addressed by their medicines Remember the appointment to refill the medicines (11/17) Kitchen (4/17) Bedroom(2/17) Living room (6/17) use containers (3/17) write the medicine purpose (17/17) use calendars or agendas Slide 24 Presence of cognitive impairment Missed appointments Complexity of treatment Reminders Complexity of treatment Guidance Motivators Treatment of asymptomatic disease Side effects of medication Patients lack of belief in benefit of treatment Presence of psychological problems, particularly depression Slide 25 Cadex www.e-pill.com MEMS www.aardex.comHelping Hand (Bleser et al, 2010 Movipill (Oliveira et al, 2010) Dispositivo para dar seguimiento Medtracker (Hayes et al, 2009) Representacin de lo datos Cadex www.e-pill.com MEMS www.aardex.comHelping Hand (Bleser et al, 2010 Movipill (Oliveira et al, 2010) Dispositivo para dar seguimiento Medtracker (Hayes et al, 2009) Representacin de lo datos (Lee y Dey, 2011) Cadex www.e-pill.com MEMS www.aardex.comHelping Hand (Bleser et al, 2010 Movipill (Oliveira et al, 2010) Dispositivo para dar seguimiento Medtracker (Hayes et al, 2009) Representacin de lo datos Technological Approaches Electronic medication- monitoring devices Reminder systems Persuasion through social games Promote reflexion Cadex www.e-pill.com MEMS www.aardex.comHelping Hand (Bleser et al, 2010 Movipill (Oliveira et al, 2010) Dispositivo para dar seguimiento Medtracker (Hayes et al, 2009) Representacin de lo datos (Lee y Dey, 2011) Slide 26 AIS for making users aware of the status of relevant and unpredictable events. AIS that notify of predictable or scheduled events. AIS to motivate a change on the users behavior. The Orb Reminder Bracelet (Hansson et al 2000) BusMobile (Mankoff et al 2003 UbiFitGarden (Consolvo et al, 2008) FishnSteps (Lin et al 2006) CareNet Display (Mynatt, 2003) Marcela D. Rodrguez, UABC25 Slide 27 Aesthetic design Modalities for grasping appropriate amount of users attention Modalities to represent information How to apply or adapt these AIS design attributes to support elders medication? 26 AIS should be perceived for the information provided (Mankoff et al, 2003). Use few sources of information (Pousman & Stasko, 2006) Consider the users life style, and cultural aspects (Jafarinaimi, et al 2005) Low cognitive effort, easy to monitor (Mattews et al, 2004) Use of semiotics (Pousman y Stasko, 2006). Promote reflexion of users abour their behavior (Consolvo, et al, 2009) Five notification levels for managing user attention (Pousman 06; Matthews et al, 2004). Criteria for measuring users interruption, reaction and comprehension (McCrickard et al, 2001) Slide 28 RemindGuide Motivate AIS Strategies To not abandon the therapeutic treatment: Psicological and persuasive techniques Abstract representations Historical information and reflection Reinforcements Slide 29 28 Medication adherence during the 3 past weeks Growth levels 3 2 1 0 Current medication week Rewards: Periquito Curro Marcela D. Rodrguez, UABC A stylized representation of medication adherence Metaphor: Birds growth to symbolize repercussions on elders health. Slide 30 RemindGuide Initiate the activity: Provide a stimulus to demand users attention Make elders aware of the importance of medicating. Motivate AIS Strategies Slide 31 30 Medicine Doses Health problem Enalapril 20:00 Timely auditory reminders Visual notifications with critical information Marcela D. Rodrguez, UABC Slide 32 Remind Guide Complete the activity: Atract users attentions to the containers medicines Provide critical information to correctly take the medication. Motivate AIS Strategies Slide 33 AIS attached to medicines to make elders aware of how to carry out the activity. Frequency Doses Health-problem Marcela D. Rodrguez, UABC32 Slide 34 Periquito curro 33 Slide 35 34 La Sra. Ana leyendo su novela Marcela D. Rodrguez, UABC 34 21:00 Slide 36 Marcela D. Rodrguez, UABC35 Slide 37 36 Objective: Identify usability problems Design recomendations Validate design dimensions 17 Inspectors: 5 Domain Experts (DE): Elderly healthcare specialists 7 Novice Experts (NE): Computer Engineering or Master Degree in Computer Science 5 Advanced Experts (AE): kwnoledge on usability engineering; C.Sc. Doctoral students Juan P. Garca Avance de Tesis Slide 38 Introduce evaluation Explanation of the systems Individual Inspection Group Discussion Discussion of: Usability problems Recommendations Barriers elders face to adopt systems Feature check list (Mankoff 03): C1- Useful and relevant information C2- Peripherality C3- Match between system and real world C4- Sufficient information design C5- Consistent and intuitive mapping C6- Easy transition C7- Visibility of status C8- Aesthetic and pleasing design C9- Strategy to assist C10- Target object of the AIS Slide 39 3 2 1 0 DE5(0)-C6: Identifying the multiple levels of growth is difficult for the patients Growth levelsFrecuencyProblem 12/17Dificulty for perceiving changes on the parakeets; therefore it is not easy to associate the parakeets behavior with the elderly medication compliance. AE1-C5-R: Include other parakeet behaviour characteristics: such as emotions, make the parakeet seem seek Slide 40 AE5(0)-C6: It will not be easy for an older adult to identify in which week he correctly or incorrectly take his medicationsFrecuencyProblem 5/17 It is difficult to identify the medication week represented by each parakeet. AE1-C1-R: use different colors for each parakeet Slide 41 DE2(1)-C1: It would be useful and more relevant to provide explicit information indicating the medicines taken and not taken, and schedules DE4-C4-D: elders need to receive an immediate reinforcement associated with their actions DE1-C5-D: Provide personalized feedback: Arthur, you did it; based on the compliance situationFrecuencyProblem 5/17 The system should provide feedback when taken or omitted the taken of the medication. 6/17 The system should provide reinforcements daily. Slide 42 DE4-D: the salt image may confuse al older adult; he may think that ir is time to consume salt 20:00 Enalapril FrecuencyProblem 7/17 Using images of food, may cause elderly associate them with medication instructions, instead of associating it with the health problem. AE3-C5-R: I suggest to modify the image to include a symbol to indicate if it is a recommended or restricted food Slide 43 DE1-C3-D: some elders present presbycusis, loss of ability to perceive high frequency sounds or distinguish between tones, therefore they may not distinguihed this auditory notificationsFrecuencyProblem 5/17 Using high frequency auditory notification, may not be perceived by older adults. 3/17 The system does not makes elders aware about thei medication complizance. AE3(0)-C6-D: The system does not allow to get additional information sbout my medication compliance. Slide 44 FrecuencyProblem 13/16 Asociate the geometric figures with the medication frequency is a complex task. 8/16 The system design is not pleasant 6/16 Interpreting the meaning of the highlited sides is a complex task 4/16 The luminosity intensity of the sides, may not be perceived by older adults Slide 45 CARE-Me should reinforce the elders behavior towards the activity. It is important to represent more detailed and additional information (Sufficient information, C4=0.81; Easy transition, C6=0.52) Daily representations of the medication compliance and present instructions for medicating (12/17). Daily rewards instead of weekly: parakeets notify appropriate and inappropriate behavior (5/17). 44 Slide 46 Remind-Me is appropriate to demand elders to timely execute an important activity. Audio alerts demand elders to timely execute an activity (11/17) (Peripherality, C2=-0.17) Mobile devices arent common objects used by elders (Harmony with the environment, C3=0.99), however elders may get used to take them anywhere (13/17). Information is sufficient and relevant (C4=1.24), but (9/17) some experts suggested to provide elders with additional information (i.e pre-conditions) 45 Slide 47 Tuning of ambient information to elders perceptual characteristics. Adjust the fidelity of information representation (metaphors) and notification modality (auditory). 6/17 evaluators (all geriatricians) stated that the parakeet whistle may be unpleasant and not easily heard. The AIS should not be in highly harmony with the elders environment to avoid they stop perceiving the ambient information (2 advanced experts). Include the elders name in the rewards phrases: to grasp her attention and open a trust linkage (all geriatricians) 46 Slide 48 Basic objects used to guide the activity, should present enough information to influence elders to carry out a current action adequately. GUIDE-Me C1- Useful and relevant information C2- Peripherality C3- Match between system and real world C4- Sufficient information design C5- Consistent and intuitive mapping C6- Easy transition C7- Visibitily of status C8- Aesthetic and pleasing design C9- Strategy to assist C10- Target object of the AIS 47 Slide 49 Strategy to assist: P1- Remember to take their medicines by timely making elderly aware of taking them P2- Guide medication intake by providing the necessary information to properly perform the medication routine P3- Motivating elders not to leave their medication by encouraging them to take their medicines and not to interrupt the recommended therapy Slide 50 Activity orientation: P4- Demand to execute an activity through a stimulus and critical information that indicate the importance of performing the activity P5- Make elders aware of critical information to complete properly their medication P6- Provide daily reinforcement to motivate elders to medicate routinely P7- Provide immediate feedback to make elders aware about the medication success or failure Slide 51 Tuning ambient information P8- Auditory notifications should be adjusted to the frequency range in which elders hear (presbycusis) P9- Use pictograms to express the rules to follow for medicating. They are stylized figurative drawings that refer directly to an object to communicate. P10- Using visual metaphors to raise awareness about medication compliance; e.g. metaphors based on the care of pets or plants to provide immediate feedback and daily reinforcements on medication compliance. Slide 52 Slide 53 CARE-Me Enhanced Design Recompensa Semanal Immedate Reinforcement Slide 54 Remind-Me Enhanced Design Slide 55 Guide the design Evaluate a design Clasify systems Identify design patterns Characterize systems by using the Design Dimensions proposed Slide 56 Stratey to assist: P1- Remember to take their medicines: Escalating alets 2 hr. window P2- Guide medication Indicate which medicine to take by emphasizing the cap P3- Motivate elders not to leave their medication Social feedback : reports can be accessed by the elders social care network Activity Orientation: P4- Demand to medicate through a stimulus and critical information: Use of different ambient modalities: lights, sounds Increment the intensity of reminders P5- Make elders aware of critical information to complete the medication Only indicate which medicine to take by emphasizing the cap P6- Provide daily reinforcement Do not provide daily reinforcement P7- Provide immediate feedback Phone calls only when he missed to take the medicine Tuning ambient information P8- Auditory notifications should be adjusted (presbycusis) P9- Use pictograms to express the rules to follow for medicating. P10- Using visual metaphors to raise awareness about medication compliance * Tuning of the intensity of alerts to not disturb the patient. Slide 57 Systematic Review: Conduct a systematic review to select relevant technologies that enable to validate the design dimensions of AIS Slide 58 What are the design principles recommended to follow for developing technologies that support medication adherence? Objectives: Identify how these technologies address the design dimensions we proposed for AIS. Identify additional design attributes Slide 59 Journal, and Conference proceedings papers (we will exclude work in progress papers: workshops, posters, doctoral symposium) Report an evaluation of the technology Report technology design/functionality Commercial available products* Slide 60 PubMed Central includes NLM Catalog, NCBI databases, MEDLINE, and uses MeSH (Medical Subject Headings). ACM enables to search conferences and journals from IEEE, Springer, and other relevant editorials (i.e. Elsevier) It will enable us not retrieve several instances of the same paper. Slide 61 % of papers retrieved Type of technology approach used (mobile devices, electronic containers, web tech., etc) Type of strategy supported Group age Type of evaluation (usability, effectivity) Slide 62 714 Citations identified by initial electronic search 139 Citations kept 137Articles to analyse (meta-analysis) 137Articles to analyse (meta-analysis) 2 Articles duplicated were excluded 575 Articles excluded (do not report technology to assist medication; work in progress) 575 Articles excluded (do not report technology to assist medication; work in progress) ? Articles excluded ? No containing description of technology ? No reporting evaluation ? Articles excluded ? No containing description of technology ? No reporting evaluation ? Systems to review to identify design principles 13 Commercial products sold for elderly. Selected from: 13 Commercial products sold for elderly. Selected from: 5 Products excluded: 4 duplicated 1 was an accesory 5 Products excluded: 4 duplicated 1 was an accesory 8 Commercial products Slide 63 62 Suggestion 1: Carry out at the beginning of your research a literature review based on a systematic review. Suggestion 2: Carry out the inspection first with Domain Experts, then with HCI Experts It is complex to identify design principles, there are no ideal or standard methodology Slide 64 Instructor: Marcela D. Rodrguez (UABC, Mxico) marcerod@uabc.edu.mx Slide 65 Encouraging people to exercise has been a major challenge over the years. Elderly who exercise on a regular basis obtain many benefits: to perform their daily activities maintain their independence improve their self-esteem and relationships 5/21/12Wellnes Interventions and HCI64 Slide 66 Design strategies for persuading: Representations of exercise routines compliance Awareness of the impact of their behavior Reinforcements Support the users personal style Competition that promotes socialization 5/21/12Wellnes Interventions and HCI65 Ubifit Garden [Consolvo et al 2009] Flowie [Merino I. et al, 2009] Fish n Steps [James J. et al 2006] PLAY, MATE! [Berkovsky, S. et al 2010] Slide 67 Challenges to implement these design strategies for motivating elders to exercise: - understand the needs and problems they have for exercising, - identify the factors that negatively and positively may impact on their motivation. design appropriate awareness mechanisms according to their perceptual levels independent elders prefer products that match their aesthetic desires and functional needs. 5/21/12Wellnes Interventions and HCI66 Slide 68 Identify how the persuasion strategies for exercising should be adapted for the elderly. Case study: Identify barriers and motivators to start and maintain a physical activity. Design: Mobile Ambient Information System to motivate elders to exercise by requiring minimal cognitive effort. Evaluation: Validate the design strategies. 5/21/12Wellnes Interventions and HCI67 Slide 69 40 minutes semi-structured interviews 10 female and non frail adults 5 active, 5 passive 5/21/12Wellnes Interventions and HCI68 Slide 70 Staying healthy is the main motivation of active elders (5/5) Coping with depression episodes (1/5) Passive elders mentioned different reasons for not being able to exercise on a regular basis. It is difficult to get the habit of exercising (1/5) The lack of social support for exercising in late life is a key barrier among older (1/5) 5/21/12Wellnes Interventions and HCI69 Slide 71 Active elders (a) have a more extended social network than passive elders (b). Slide 72 5/21/12Wellnes Interventions and HCI71 Abstraction: Metaphor based on gaining virtual coins interchangeable for time for accessing games. Triggers: daily reminders and time-based notifications to reach an exercising goal. Slide 73 5/21/12Wellnes Interventions and HCI72 Historical information and reflection: representation of the complied, and planned exercising goals. Positive and playful reinforcement: rewards that do not make them feel punished, and promote socialization. Slide 74 A formative evaluation to obtain the elders perception regarding the effectiveness of the systems persuasion strategies, and assessing the users interruption, reaction and comprehension. One-day evaluation with 15 persons (63 to 86 years old). We observed and interviewed the participants. 5/21/12Wellnes Interventions and HCI73 Slide 75 Abstraction. The metaphor was well accepted by all of them: enjoyed to track their goals( 6/15) like to obtain gold coins or diamonds (6/15) wearing the device, which [it] is modern (3/15) Historical information & reflection. Participants (11/15) emphasized the calendar was useful to realize if they pursued or have proposed goals: ... Realizing that I did not exercise one day, it would make me to effort for the next day. 5/21/12Wellnes Interventions and HCI74 Slide 76 5/21/12Wellnes Interventions and HCI75 Trigger. The notifications are easy to comprehend, but the ambient noise may impede they were perceived: Half of the participants (8/15) perceived the audible notifications, However, we noticed that some participants (7/15) observed it while exercising. Positive and playful reinforcement. Receiving access time to play games would be fun and a useful reward for motivating them (9/15). Slide 77 5/21/12Wellnes Interventions and HCI76 Playing games may be not an adequate motivational factor for elderly (12/15) 5 participants suggested to use other type of rewards regarding to manage their health I would like to get permission to eat food restricted to consume by my physician; a desert; a free consultation with a nutritionist 7 would like to receive rewards that promote socialization out of their homes: But I would like to win trips as rewards.; , going out or a meeting with friends Slide 78 5/21/12Wellnes Interventions and HCI77 Visualizing the goals that were not pursued were perceived (3/15), as a factor that may negatively impact their motivation [I would like the system to] eliminate copper coins, since they are negative; copper coins; I would like to see just gold coins. Slide 79 We understood that one of the main motivators for exercising is to have the opportunity to extend their current social network. They perceived that providing representations of the compliance of their short-term goals was useful; however. We also identified that they perceived as negative feedback to be informed of the proposed goals that were not pursued. 78 Slide 80 Marcela D. Rodrguez Autonomous University of Baja California, UABC, Mexicali, Mxico marcerod@uabc.edu.mx Slide 81 CARE-Me GUIDE-Me Remind-Me NA C1- Useful and relvant information C2- Peripherality C3- Match between system and real world C4- Sufficient information design C5- Consistent and intuitive mapping C6- Easy transition C7- Visibitily of status C8- Aesthetic and pleasing design C9- Strategy to assist C10- Target object of the AIS 80 Slide 82 Instructor: Marcela D. Rodrguez Universidad Autnoma de Baja California Facultad de Ingeniera Posgrado MyDCI, rea Computacin Slide 83 Slide 84 Slide 85 Slide 86