title: Evaluating user perceptions of mobile medication management applications with older adults: a usability study.
abstract: BACKGROUND
  Medication nonadherence has a significant impact on the health and wellbeing of individuals with chronic disease. Several mobile medication management applications are available to help users track, remember, and read about their medication therapy.
  
  
  OBJECTIVE
  The objective of this study was to explore the usability and usefulness of existing medication management applications for older adults.
  
  
  METHODS
  We recruited 35 participants aged 50 and over to participate in a 2-hour usability session. The average age ranged from 52-78 years (mean 67 years) and 71% (25/35) of participants were female. Each participant was provided with an iPad loaded with four medication management applications: MyMedRec, DrugHub, Pillboxie, and PocketPharmacist. These applications were evaluated using the 10 item System Usability Scale (SUS) and visual analog scale. An investigator-moderated 30-minute discussion followed, and was recorded. We used a grounded theory (GT) approach to analyze qualitative data.
  
  
  RESULTS
  When assessing mobile medication management applications, participants struggled to think of a need for the applications in their own lives. Many were satisfied with their current management system and proposed future use only if cognition and health declined. Most participants felt capable of using the applications after a period of time and training, but were frustrated by their initial experiences with the applications. The early experiences of participants highlighted the benefits of linear navigation and clear wording (eg, "undo" vs "cancel") when designing for older users. While there was no order effect, participants attributed their poor performance to the order in which they tried the applications. They also described being a part of a technology generation that did not encounter the computer until adulthood. Of the four applications, PocketPharmacist was found to be the least usable with a score of 42/100 (P<.0001) though it offered a drug interaction feature that was among the favorite features of participants. The usability scores for MyMedRec (56/100), DrugHub (57/100), and Pillboxie (52/100) were not significantly different and participants preferred MyMedRec and DrugHub for their simple, linear interfaces.
  
  
  CONCLUSIONS
  With training, adults aged 50 and over can be capable and interested in using mHealth applications for their medication management. However, in order to adopt such technology, they must find a need that their current medication management system cannot fill. Interface diversity and multimodal reminder methods should be considered to increase usability for older adults. Lastly, regulation or the involvement of older adults in development may help to alleviate generation bias and mistrust for applications.
authors.affiliation: School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada. kgrindrod@uwaterloo.ca.
authors.forename: Kelly Anne
authors.initials: KA
authors.lastname: Grindrod
authors.forename: Melissa
authors.initials: M
authors.lastname: Li
authors.forename: Allison
authors.initials: A
authors.lastname: Gates
keywords: mHealth; medication adherence; medication therapy management; mobile health
references.citation: Evid Rep Technol Assess (Full Rep). 2012 Sep;(208.4):1-685
references.pmid: 24422970
references.citation: Br J Clin Pharmacol. 2007 Apr;63(4):488-93
references.pmid: 17076693
references.citation: Am Heart J. 2006 Sep;152(3):454.e1-8
references.pmid: 16923412
references.citation: Gerontology. 2013;59(6):564-70
references.pmid: 23969758
references.citation: Qual Health Res. 2007 Oct;17(8):1137-48
references.pmid: 17928484
references.citation: J Adv Nurs. 1998 Aug;28(2):345-52
references.pmid: 9725732
references.citation: Arch Intern Med. 2006 Sep 25;166(17):1842-7
references.pmid: 17000940
references.citation: Int J Qual Health Care. 2007 Dec;19(6):349-57
references.pmid: 17872937
references.citation: Psychiatr Serv. 2012 Sep 1;63(9):920-8
references.pmid: 22706887
references.citation: J Adv Nurs. 2014 Jan;70(1):46-59
references.pmid: 23590348
references.citation: J Am Med Inform Assoc. 2011 Jan-Feb;18(1):51-9
references.pmid: 21131605
references.citation: Int J Clin Pract. 2011 Sep;65(9):954-75
references.pmid: 21849010
references.citation: Health Rep. 2009 Mar;20(1):37-44
references.pmid: 19388367
references.citation: N Engl J Med. 2005 Aug 4;353(5):487-97
references.pmid: 16079372
references.citation: J Affect Disord. 2014 Feb;155:110-7
references.pmid: 24262639
references.citation: Annu Rev Pharmacol Toxicol. 2012;52:275-301
references.pmid: 21942628
references.citation: J Med Internet Res. 2013 Jan 04;15(1):e1
references.pmid: 23291245
references.citation: Int J Clin Pract. 2008 Jan;62(1):76-87
references.pmid: 17983433
references.citation: BMC Geriatr. 2013 May 06;13:43
references.pmid: 23647949
references.citation: J Med Internet Res. 2011 Sep 22;13(3):e65
references.pmid: 21979293
references.citation: Circulation. 2009 Jun 16;119(23):3028-35
references.pmid: 19528344
references.citation: Am J Respir Crit Care Med. 2010 Mar 15;181(6):566-77
references.pmid: 20019345
references.citation: J Med Internet Res. 2013 Apr 24;15(4):e89
references.pmid: 23615332
references.citation: JAMA Intern Med. 2013 Feb 11;173(3):210-8
references.pmid: 23277199
references.citation: J Card Fail. 2011 Aug;17(8):664-9
references.pmid: 21807328
references.citation: J Fam Pract. 2011 Apr;60(4 Suppl Improving):S1-8
references.pmid: 21472145