Developing a mobile health medication self-management system for persons with mild cognitive impairment

Purpose Mild cognitive impairment (MCI) is characterized by mild impairment in one or more cognitive functions and is associated with an increased risk for failure to take prescribed medications. A study found that 49% of persons with mild cognitive impairment (PwMCI) report difficulty remembering to take medications (Campbell et al., 2016). An underlying deficit in prospective memory contributes to such medication nonadherence (Woods et al., 2008). A strategy to support medication adherence for PwMCI is to leverage the advances in mobile health (mHealth) technology to fosters medication self-management by tapping into preserved skill learning and procedural memory (De With et al., 2021; Gobel et al., 2013). A theory-based, mHealth system called Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) has been developed to support medication adherence in cognitively normal older adults. For such mHealth system to be beneficial for PwMCI, it has to be carefully designed/adapted to meet the unique capabilities and limitations of this population. We will present how we addressed the unique needs for mHealth technology use in this population of PwMCI based on user-centered design to inform the redesign of MEDSReM to develop the Medication Education, Decision Support, Reminding, and Monitoring-Memory (MEDSReM-M) system. Methods We conducted heuristic evaluation, cognitive walkthroughs, and needs assessment to guide redesign of the original MEDSReM system. Heuristic evaluation was conducted by 4 User Interfaces/User Experience (UIUX) experts including one external to the project team guided by Nielsen's 10 usability heuristics to uncover general problems PwMCI would encounter in using MEDSReM. Cognitive walkthroughs were done by 12 subject matter experts (SMEs) with varying expertise in cognitive aging, cognitive impairment, nursing, hypertension management, human factors, and health technology to identify aspects of the interface that could be challenging for PwMCI related to 12 tasks that support hypertension medication adherence (e.g., medication reminders; track weekly progress with medication taking). We interviewed two SMEs, a board-certified behavioral neurologist, and a clinical cognitive neuroscientist, both experts in MCI and dementia, to obtain feedback about potential usability issues for PwMCI. Results and Discussion Outcomes of heuristic evaluations suggested areas of improvements in visibility of system, user control and freedom, error prevention, and flexibility of use. Cognitive walkthroughs revealed the need to simplify the user interface and provide more direct and prescriptive instructions to minimize decision making demands. Needs assessment involving SMEs corroborated the need to simplify the system by minimizing options that require decision-making (e.g., skip medication) to minimize errors, and improve the visual layout to ease navigation. The usability challenges identified through heuristic evaluation and cognitive walkthrough along with the SME feedback guided the first iteration of the MEDSReM-M development. Our findings also inform the design of mHealth intervention systems to support self-management and autonomy in PwMCI.