mentos virtual pet

Virtual Companion to assist with Medication Adherence

Jan - Apr 2022

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Cognizant

background

Over 50% of Americans don't take their medications as prescribed. Type 2 Diabetic patients have the lowest medication adherence at 31%, the consequences of poor medication adherence for this specific group had the most serious outcomes, and the high cost burden of the medications for this disease.

We explored various causes, identified key issues and narrowed our scope to resolve medication adherence for elderly patients with Type 2 Diabetes. Our solution - a virtual pet assistant that helps T2DM patients with disease management.

Simple, Error-free Setup

Organizing complex and frequently changing medication regimen with object-character recognition

Reminder and Confirmation for Complex Medication Regimens

Motivational reminders and confirmations to prevent mix-ups in medications.

01

Research

We conducted literature research and speaking with Cognizant's subject matter experts who were chief medical officers, HMO/PPO plan consultants and health technology experts to identify, and clarify main causes of medication non-adherence.

5  Causes of Non-Adherence

MENTAL

Poor self-perceived health status
Comorbidities

FINANCIAL

High cost of treatment

EMOTIONAL

Fear of medication side-effects
Fear of injections

KNOWLEDGE

High treatment complexity
Understanding of disease
Forgetfulness
Lack of perceived benefit
Understanding of hypoglycemia

KNOWLEDGE

Unclear instructions from medical providers
Insufficient family support
Low trust in provider

02

Ideation

With our research, our team kicked off our first brainstorming session to generate, share and organize ideas. After a few hours of brainstorming and documenting, we categorized our ideas by educational and emotional support to make sure they meet our design goals from our problem statement. Then, we categorized by digital or physical solution to measure feasibility.

We narrowed down to three ideas based on the the number of votes each team member assigned by how it could met our design goals. The three that met most of our design goals were the ones we moved forward with and did further research and idea exploration on., which was Community Chat Application, Rx Management Dashboard and Virtual Pet.

A social platform specifically designed for diabetes patients that focuses on emotional support and having questions answered by medical professionalsOur research showed that peer support communities are often used by patients. Peer support communities, both online and in-person, can help fill in the gap of continuing support.

Social communities that center around a disease state exist in online forums, Facebook groups, and disease-awareness organizations, which offer a sense of community and an outlet of support for the day-to-day challenges of managing diabetes.

The RX Management Dashboard for Diabetic patients provides a daily overview of personal health status and reminds patients to take their medications.With more research, we also learned that behavioral changes occur with extensive knowledge of personal health. Mobile health platforms which display patients’ information empower patients with a sense of self-efficacy and motivate them to be proactive. Current existing solutions however, may be overwhelming and cause information overload. Examples are on the right side:

Problem - Overwhelming amount of data that may not be pertinent to our target user Requires self-management of complex dataUI components are small and inaccessible for elderly patients

Plan - We decided to explore simpler UI with features that match more target user-specific needs that we will gather from user research.We would address the weaknesses by creating a simpler app targeted for diabetes patients that

Requires less management by auto-syncing with information that providers have Displays a simpler UI that is easier to interact with Provides digestible educational support

Strengths:
Visual display of medications
Monitors drug side effects / personalization
Scheduling for health managementSyncs with pharmacy software instantly

Weaknesses:
Can get tired / desensitized to displayed information
Only for at-home use
Doesn’t account for all side effects

After exploring various ways of emotional support, we decided to bring a pet concept. According to, Association Between Dog Ownership and Type 2 Diabetes in Later Life, we were able to identify that dog ownership has been reported to have beneficial effects on physical activity and emotional well-being, both known to reduce the risk for type 2 diabetes, such as easing mental health condition, such as anxiety, depression, or phobias, increasing physical activities, providing companionship, help meeting new people, add structure to the day

These advantages allow us to enter the virtual pet concept as we believe that emotional support is a powerful motivator for patients to successfully take their medication and take an active interest in their personal health. The virtual pet application could remind them to take their medication, but also encourage them to engage in the physical activity that diabetics need.

03

Refine

To decide the design direction of our final solution we first presented our solution our peers, advisor and professor. By nature of a pet being a part of an owner’s every day life, we felt our Virtual Pet idea could address medication adherence holistically. We saw many opportunities to provide features that would meet our outlined design objectives. Compared to our other ideas, Virtual Pet met most of our design objectives.

We brainstormed our key features by referencing our initial design objectives. Then we discussed together brainstorming how we can provide solutions for existing problems through pet interaction. We listed the narrowed down idas using paper and pencil, and created a storyboard to align on ideas and present for concept validation. Our key features to explore were:

Physical Exercise
Medication Reminder
Learning Disease State
Mood Tracking

How to Encourage Daily Exercise

When we initially brainstormed the physical activity feature in the virtual pet application, we considered an AR experience that places a virtual pet on the camera screen where the user is, as it can provide an engaging experience for potential users. We believed that AR experiences could make users feel that the virtual pet is physical with the user. However, when we evaluated with our mentor, Marcia, the danger of the AR experience became a cause for our concern, we realized road injuries incurred by people playing video games on mobile phones while walking.

To avoid the potential risks that the application could present in an AR background, we decided to implement a bird-eye view map, although it is not as engaging as an AR experience. We thought a bird-eye view map would be effective because users are familiar with the map background and can easily track their location while walking. However, some of the feedback we received when we did initial concept was that the feature seemed unappealing and the experience was less immersive.

The final design we decided to come up with for the physical activity feature was to have a cartoon background that would allow virtual pets to be shown. Virtual pets will show their back as the user walks, as if the user felt like they were walking with their virtual pet. However, when the user stopped, we created a design that made the virtual pets look back at the users and indicate to them how their walking process is going.

For better engagement, we also decided to introduce a camera component where users can take pictures of their virtual pets using the camera feature on their phone. Virtual pets will show up on the user’s camera screen. In this way, users would feel engaged and immersed in the experience. Based on research and discussions with mentors and professors, we realized that it would be a good idea to have these features, as users wouldn't have to pay attention to the app while walking, but they can easily choose to interact with their virtual pet at any stage of physical activity.

Easier Setup Experience using OCR

As the primary goal of our application is for medication adherence, we wanted to make sure our application addressed the existing issues that were present in existing medication reminder systems, while simultaneously thinking about how to increase adherence, not from a reminding standpoint. In our initial research, we discovered the following pain points in digital pill reminding systems: a complex setup experience and lack of motivation.

Leverage OCR for Easier Set-Up

The idea we moved forward with was to simplify the medication setup process by leveraging optical character recognition (OCR). Instead of having patients type in their prescription information that can change frequently, patients could simply take a picture of their medication label. The application on the back end can use OCR to correctly recognize the directions for medication and set up reminders as needed. We were able to test this by using Google’s Cloud Vision API. By adding a link to this example label image from CVS, the API was able to return a string of text that accurately matched what existed in the label, which we thought would be a promising solution to reduce the setup burden for patients.

Connecting with EMR/Pharmacy Software

Another consideration we made as to simplify the experience by connecting with doctors’ EMR software and pharmacy software. This would require no effort on the patients’ end to add their medication information. Additionally, the information that the application collects from the doctor and pharmacy software would always be up to date.

How do we verify medication taken?

To provide the proper feedback, we needed to make sure the app can verify the patient took their medication. This was important not only for feedback but also because one listed reason for patient non-adherence was because they simply forgot if they took medication that day or not. Because of the fear of overdosing, patients chose not to take their medications. Another important reason to verify the patient took their medication is for health monitoring purposes. Having this data can give providers valuable health data if the patient chooses to disclose it. This would provide more information for health care providers to properly assess and treat the patient throughout their journey.

Idea 1: Physical Pill Dispenser

As we wanted to leverage existing technologies and provide an experience that is less focused on mobile screens, we explored the potential of syncing with an automatic pill dispenser. Here the patient would take the medication from the pill dispenser, and the information would be sent back to the mobile application.

Strengths: Can accurately measure pills taken from the dispenser
Weaknesses: Difficult to manage multiple medicationsHard to travel with

Idea 2: QR Code

After a discussion with our advisor, we explored the idea of scanning a QR code of the pill vial. In this scenario, the patient can scan the QR code on the pill vial each time to verify that they took the medication. Because our target group does not have high tech literacy, we wanted to limit screen time as much as possible. However, the socio-economic considerations of having to purchase a separate pill dispenser led us to decide on using the mobile phone to verify medication taking.

Strengths: More portable option and allows for travel
Weaknesses: Patient may be traveling with pill organizers QR codes may change for each re-fill, having to re-setup app

Idea 3: Pill Scanning

Our final idea was to use image recognition to verify taking the medication. In our research, we discovered the drugs.com Pill Identifier database that contains images of all existing medications on the US market. By integrating this data with the application, we can verify if the patient took medication. While we decided to move in the direction of using the mobile phone to verify taking medication, we had some concerns regarding the QR code.

Patients may carry their medication in separate pillboxes, and not have the QR code with them. Additionally, patients will receive new QR codes with each new medication refill, requiring setting up the app again.

Strengths: Accurately document medications taken/missedVerify pill and reduce medication errors
Weaknesses: Initial Learning curve and habit formation

04

Test and Deliver

We decided to create high-fidelity wireframes from our original mid-fidelity wireframes before usability testing, as our key tasks were scanning the pill and vial, which would involve a high fidelity image from a camera, and an AR experience that would also incorporate a real photo. Instead, we completed a cognitive walk-through with our professor and advisor to validate the sequence of screens in our mid-fidelity wireframes. We then incorporated feedback, created high fidelity wireframes, and then planned our usability testing.

Our primary testing goals were to make sure the app user flow worked as intended, confirm that it was easy to use, and simple that users were focused on the immediate task they had to complete on the application. We tested 5 key flows which were logging in, medication setup, taking medication, checking mood, and going for a walk. We used 5 points Likert scale to gather quantitative data on users’ ease of use for each user flow. We also gathered qualitative data by asking open-ended questions to learn what part was memorable, noticeable, and delightful.We recruited 5 testers from family and family friends that met our target population demographics. 4/5 testers had type 2 diabetes, and 1/5 of testers were not diabetic but took chronic medications. We assigned testers each task and asked to follow up questions as per the document below. We collected our data and analyzed them together in a group debrief.

Our primary testing goals were to make sure the app user flow worked as intended, confirm that it was easy to use, and simple that users were focused on the immediate task they had to complete on the application. We tested 5 key flows which were logging in, medication setup, taking medication, checking mood, and going for a walk. We used 5 points Likert scale to gather quantitative data on users’ ease of use for each user flow.

We also gathered qualitative data by asking open-ended questions to learn what part was memorable, noticeable, and delightful.We recruited 5 testers from family and family friends that met our target population demographics. 4/5 testers had type 2 diabetes, and 1/5 of testers were not diabetic but took chronic medications. We assigned testers each task and asked to follow up questions as per the document below. We collected our data and analyzed them together in a group debrief.

final thoughts

Healthcare design is very complex, and shifting people's attitudes towards it is not easy. To reduce the mental load and making medication adherence feel like a chore, we explored how we can shift that mindset to a more fun approach.

As we narrowed our target group to T2DM medications for its potential impact, we also learned the special difficulties T2DM patients face with medication adherence. T2DM patients have complex and frequently changing medication regimens that are hard to keep track of, especially if patients have hospital visits, changing physicians, and with age- less cognitive ability and social support.

A learning point from this project was - to effectively prioritize features. As a conceptual project, it was very tempting to try to solve for every cause which led to a

feature-bloated product. I would also explore other IoT solutions that could make the process easier. For example, maybe medication confirmation can be done through a Nest camera, or a tablet installed in a wall so users can freely use both hands. Maybe the pet can be more life-like if it was projected on a TV screen.

My biggest takeaway from this project was that some solutions warrant a more emotional approach. Discovering that patients use facebook forums and reddit groups for support in their diabetes journey was a huge learning point. That medication adherence, or patient attitude towards better health may not be an issue of memory, rather a social and emotional one.

View Process Book →
credits and special thanks

linda lee ux
yuyang luo ux & illustration
marcia tourtellot healthcare it sme
wendell wilson advisor
cognizant sponsor

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