ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels

Abstract

BackgroundIn order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels.ObjectiveThe aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition.MethodsThis pilot study enrolled adults (≥55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes.ResultsThe 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the “drag and drop” function.ConclusionsClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow.

Effectiveness of the Apple iPad as a Spot-reading Magnifier

“…The need and relevance for developing the use, utility, and usability of tablet computers in the context of low vision have previously been highlighted by Grindrod and colleagues, 17 who developed an app specifically for use with the iPad designed to assist individuals with reading difficulties (e.g., due to low vision) when accessing medication labels. Others have pointed toward the utility of voice output on tablets and smartphones when managing diabetes and low vision due to diabetic retinopathy through assistive technology and medical devices.…”

The role of interdisciplinary research team in the impact of health apps in health and computer science publications: a systematic review

“…College of Medicine 5. Department of Physical Therapy Grindrod et al [ 17 ] Technological improvement Journal Of Medical Internet Research mHealth and uHealth Not indexed Not indexed – 0 1. School of Pharmacy 2.…”

“…The techniques and recommendations were based on the scientific literature. From the 14 identified as potentially efficient in behaviour change, the monitors included between 5 and 10 Paper 27: ClereMed: lessons learned from a pilot study of a mobile screening tool to identify and support adults who have difficulty with medication labels Grindrod et al [ 17 ] The study presents a prototype of an app (“ClereMed”) to identify people who have difficulty reading, poor ability in handling medication and cognitive impairment, and to assess the acceptance of touch devices in older people. We Studied 47 elderly.…”

User Goals Extraction for a mhealth-based Medication Management System for Individuals with Visual Impairment

“…The evidences in these researches show that the challenges experienced by visually impaired people can be categorize in nine types. Unavailability of information sources [32], difficulty in reading the information of medication labels [23,25,32,49,50,51,52,53], inappropriateness of medical equipment and technologies for this group [25,53], occurrence of medical errors [25,32], difficulties in identification of different medications [25,32,49,52], difficulties in opening the containers, bringing the medications out and medication intake [23,25,32,52,53,54,55], loss of privacy and independence [25,56] and problems in remembering the medication schedule [25,32] are the types of challenges which have been experienced by people with visual impairment.…”