Problem
Each year, 1.7 million people in the US sustain a Traumatic Brain Injury. Even more powerful, an estimated 5.3 million Americans of all ages have Alzheimer’s disease, with another American being diagnosed every 67 seconds (Alzheimer’s Association, 2015). The population of those with memory loss or minor cognitive impairments is growing and the problems that this community faces in regards to medication management are becoming more obvious. To ensure that medication is taken correctly, it is often necessary for loved ones to step in as caregivers. Regrettably, this decreases patient independence and can eventually lead to caregiver burnout. As a result, patients and caregivers alike would benefit from new tools for managing medication and reducing cognitive load.
With this in mind, our team of undergraduate seniors in the department of Human Centered Design and Engineering set out to answer the design question “How can we help people with medical memory loss manage their medications independently?” After ten weeks of user research, ideation and prototyping, we have created a device entitled the MedMem Medication Management System. This low tech solution consists of three interconnected components: customizable pill boxes, a portable reminder system, and a pre-formatted notebook. As a whole, the MedMem system allows users to easily adapt to frequently changing medication regimens, remember medications through persistent notifications and externalize important medical information.
Process
MedMem is a senior capstone project intended to help individuals with medical memory loss manage their medications independently. Our team addressed this problem using a human-centered design approach with a focus on three phases of the design process: user research, ideation, and prototyping.
To ensure that we maintained a deep understanding of our user groups, we focused heavily on user research throughout our project. We began with a literature review to frame our understanding of memory loss and medication adherence. We then ventured into the field and conducted four foundational interviews with five members of our target audience: one doctor, one Traumatic Brain Injury (TBI) patient and caregiver team, and one Dementia patient and caregiver team. These interviews gave us further insights about the difficulties of managing medications and allowed us to truly empathize with our users.
After performing thorough user research, we began brainstorming design solutions. Each team member generated numerous sketches outlining features of potential products. The team then came together and compiled ideas. In the end, we decided on a three prong approach to medication management. This included customizable pill boxes, a portable reminder system, and a notebook for recording important medical information.
During the final phase of our project, we made our ideas tangible by creating a series of prototypes. This allowed us to both evaluate the feasibility of our design and help users visualize our product. Over a four week period, we were able to experiment with rapid prototypes, collect user feedback, generate refined digital models and build a set of refined conceptual prototypes.
The final product utilized a variety of prototyping techniques and materials that created the illusion of a functioning system. Overall, our prototypes effectively demonstrated the purpose of our designs and the importance of the MedMem system as a tool for medication management.
User Research
For the first phase of our project, our team conducted user research to ensure that all design decisions would be grounded in facts rather than assumptions. Throughout the course of our research, we created three notable artifacts: an annotated bibliography, notes from interviews and a collection of user personas.
Annotated Bibliography
Entering a broad and complex design space, our team began our research with a short literature review to identify stakeholders and problem areas in the realm of medication management. Carefully weighing time constraints, we collected and read a total of 11 relevant articles. Topics ranged from the needs of dementia patients to the design of effective notifications systems.
“Medication management in dementia is a broad concept that should encompass a complete review of medication, including assessment of indication, dosage, interactions and continued need.”
-Maidment et al
“The literature suggests that older adults often rely on contextual clues (e.g., taking medications with a meal) and automatic or ritualized behavior to remember to administer their medications.”
-Cotrell, Wild & Bader
In turn, we worked to synthesize important information through an annotated bibliography. This document was used as a common frame of reference for our group’s understanding of the design space. It also serves as list of quotes and references that can be used for support in a final presentation or process book.
Interview Notes
After conducting a literature review, our team identified three primary stakeholders: patients, caregivers and medical professionals. In order to learn more about user needs and perspectives, we reached out to potential participants through email, phone. We were able to schedule in person interviews with a total of five target users. Interviews were conducted in the field over the course of one week.
Participants were as follows:
- Medical professional. A doctor involved with Alzheimer’s and Traumatic Brain Injury research at the Department of Veterans Affairs.
- Dementia patient and her caregiver. An elderly husband and wife team that have been managing dementia for over three years.
- Traumatic Brain Injury patient and his caregiver. A middle aged male whose mother served as a primary caregiver following his accident.
In addition to these formal interviews, our team also visited Aegis, a local assisted living facility with a wing for Alzheimer’s care. During the tour, our team informally interacted with patients, nurses and medication administrators.
Overall, our research allowed us to build understanding and empathy for users needs. We were able to see what methods people were using to manage medication, hear about pain points in their experience and engage participants in the design process. Many users were also eager to describe features that they would like to see in an improved medication management system.
“It’s a big deal when one of my visual cues gets moved.”
“You get used to it [opening a pill box compartment] , you know it’s going to be tough.”
“Any crutch we have, we would lean on immediately.”
Images of medication management systems presented during interviews
Personas
After talking to users and seeing their medication related frustrations first hand, we created three personas to document the wants and needs of our target users. These personas will be internalized and used to guide design during the idealization phase of our project. All information presented in the personas is drawn from our interviews and literature review.
Ideation
After conducting user research and coding our data for themes through affinity diagramming, our team moved into the ideation phase of our project. The purpose of ideation was to generate a promising design that could be built in full during our prototyping phase. Four artifacts were created during ideation: a list of design requirements, a collection of potential design sketches, three refined sketches for user feedback and a summary of user feedback.
Design Requirements
Drawing directly from user research findings, our team compiled a list of design considerations to refer to during ideation. Additionally, we pulled out the most pertinent design considerations and created a top ten design requirements list. By generating ideas that satisfied these design requirements, we ensured that potential products would, indeed, be beneficial to users within our design space.
Features of a successful medication management system are listed in the following documents:
[gview file=”http://www.gailthynes.com/medmem/wp-content/uploads/2015/04/FinalDesignRequirements.pdf”%5D
[gview file=”http://www.gailthynes.com/medmem/wp-content/uploads/2015/04/FinalDesignConsiderations.pdf”%5D
Brainstorming
To start off the idea generation process, each team member created several unique sketches of design ideas. These sketches depicted user experiences, user interfaces, and medication management tools. Each sketch was also intended to align with our list of design requirements that was generated after user research. Original sketches can be viewed in the photos bellow.
Final Sketches
After coming together and combining design ideas, our team discovered that a medication management system can encompass three subcategories: medication organization systems, reminder systems and record keeping systems. As a team, we developed a final design that considers each of these areas and that we feel would successfully satisfy user needs. Finally, we created three refined sketches of the design to present for user feedback.
User Feedback
To ensure that our designs were meeting user needs, we presented our refined sketches to users for feedback. Overall, our design concept received an overwhelmingly positive response.
“I think this would be very helpful.”
“Fabulous!”
“That would be really good.”
Nevertheless, there is always room for improvement. Design suggestions from user feedback are summarized in the following document:
[gview file=”http://www.gailthynes.com/medmem/wp-content/uploads/2015/04/DesignFeedback.pdf”%5D
Prototyping
The MedMem Medication Management System
After selecting a final design and clearly sketching it out on paper, it was time to make our ideas tangible. Prototyping allowed us to put our product in the hands of our users as we gathered feedback. We were able to test the feasibility of different form factors, pill box connecting materials, light sources and writing surfaces. Overall, prototyping brought us one step closer to a polished, user friendly product. This phase of our project included a series of rapid prototypes, user feedback and refined prototypes.
Rapid Prototypes
Rapid prototyping is just as it sounds: assembling a model of something very quickly. These low fidelity prototypes were fantastic for testing several design details simultaneously and at low cost. What material is best for connecting pill boxes: magnets or snaps? Glue them both to some cardboard and find out!
Systematically, we created a series of rapid prototypes of our three design components. For our pill boxes, we used small cardboard boxes with binder slips on the lids. Different connecting pieces were glued to the boxes as illustrated in the images bellow.
PillBox
Reminder System
Next we built a small reminder system, experimenting with ways to wire lights around the writing surface. Bellow you can see how we moved from a bare bones whiteboard with lights to a slightly more polished cardboard version for user feedback.
Medical Notebook
Finally, we mocked up some content pages for our medication journal and glued them to the pages of an existing notebook. We used this to test line spacing and the applicability of pre-formatted content.
Demo
To showcase how each of these pieces work together, we created a short demo video using rapid prototypes. This video was later shown to potential users for feedback.
Empathy Testing
Using gloves, clouded glasses and a distracting soundtrack, we tested our rapid prototypes with consideration for our users who may have reduced sense of touch, vision impairments and/or mild cognitive impairments. This empathy testing allowed us to put ourselves in the shoes of our users and maximize the usability of our design.
Interestingly, we found that Lego pieces were the most effective concept for connection. They were easy to connect and had a tight hold due to their large surface area. When wearing our modified glasses (intended to simulate Glaucoma and Cataracts) we were also surprised to find that a small LED on each box was also more visible than the EL wire that we had previously favored. These testing tools likewise reinforced the importance of maximizing space for labels written in larger text. Although, the light in individual pill compartments greatly alleviated the challenge of reading labels with impaired vision.
User Feedback
In order to get feedback on our design, we created a video demonstrating how the product works. We then ran focus groups and sent emails to potential users where we explained our product, showed the demo video, and asked questions for feedback. The questions we asked were:
- What, if anything, do you like about this product?
- What, if anything, do you dislike about this product?
- Do you have any suggestions for improving this product?
- Do you see yourself using this in real life? Why or why not?
- Do you think the pillbox, reminder system, and notebook work well together? Why or why not?
We reached out to users from our target audience for feedback. However, in order to maximize the amount of feedback that we received in a very short amount of time, we also reached out to members of a more general audience: anyone who takes at least one medication regularly, regardless of whether they suffer from memory loss.
Overall, participants responded positively to the MedMem system. However, improvements including larger label slips were integrated in our refined prototypes.
[gview file=”http://www.gailthynes.com/medmem/wp-content/uploads/2015/04/UserFeedback1.pdf”%5D
Refined Prototypes
One lesson that we learned while creating refined prototypes is that there is more than one way to convey an idea. Originally, our team decided that 3D printing was ideal modeling our Lego style snap system. Unfortunately, the 3D printers that we had access to were not precise enough for the job. Lids came out the wrong size and the snaps did not fit together. Testing a different snap styles proved more troublesome. The printer was unable to render the finer details of the snap.
After several failed printing attempts we took a step back and discovered another method to build the pillbox. We laser cut acrylic and built up pill boxes in layers. Instead of our snap design, we added clear Velcro circles to simply convey the idea of connection.
Our reminder system is a laser cut mat board panel mounted on foam and strung with lights. Buttons are made from clay and a small clock is taped into the slot for an LCD screen.
Our medication journal was revised from our original templates. While they are elegantly simple, integrating color and icons improved the visual design from our previous iteration. We had them professionally bound to improve the fidelity and provide a more realistic experience for our users.
Results
Ultimately, our team was able to research, design and prototype a medication management system that satisfies human needs. The MedMem system takes a three prong approach to medication management. This includes customizable pill boxes, a portable reminder system, and a notebook for recording important medical information.
In future work, our team would like to further develop, integrate and test the details of our device’s digital interface. At it’s current stage, our prototype remains largely conceptual. We would also like to experiment with ways to implement our intended pill box connection mechanism. It is possible that we can achieve the desired effect with a more precise 3D printer, but will more likely require some plastic and mold making expertise.
Over the course of this project, our team learned a great deal in regards to collaborating and executing multiple phases of the human-centered design process. We worked tremendously well together despite several hurdles along the way. Thus, we welcome the possibility of working together again on similarly fulfilling projects.
Megan Taylor 