Medicine Compliance for Generation X Team 1: Ankita Arvind, Chris Holliday, Michael Li, Cheng Li (Vanessa)

User and Market Research

Phase I: Background Research

To begin, our team conducted preliminary research to guide our future research and help

to formulate well directed and educated questions. In order to ensure pertinent and up to

date information, we limited our sources to those published within the last 10 years. The

channels we used included but were not limited to: Google Search, Google Scholar, Google

News, Youtube, Slideshare.net, WHO and other organizations’ reports.

Phase II: Initial Subject Canvassing

To further our understanding of issues that affect medical compliance in Generation X, we

created and conducted a short survey to distribute to as many qualified people (part of

Generation X, taking prescriptions, following a prescribed exercise plan, etc.) as we could

find. We accomplished this by distributing a paper survey to people waiting for their

prescriptions in drugstores in Pittsburgh. Additionally, we sent the surveys out to friends

and family who were in our target age range.

Phase III: In Depth Subject Interviews

Based on the results from our initial survey, we conducted 8 in-depth interviews with a

variety of qualified subjects, five of whom are Generation X. From these conversations, we

gained a deeper understanding of what influences Gen Xers medical compliance, and

pushed the subjects to think more deeply about what influences them. We selected these

individuals during Phase II, by asking those surveyed whether they would be willing to

participate further in our study and conducted the interview then and there. We also

reached out to those we have personal connections with for this part of the study.

Phase IV: Heuristic Analysis

We conducted a heuristic analysis study of a medicine compliance app named ‘MedCoach’

which was aimed at helping people organise their medicines and set up reminders for their

doses.

Phase V: Image Board and Scenarios

We created a scenario revolving around our combined persona to get a better

understanding of a day in the life of the average Gen-Xer who taked medicine. We also

created an image board to stimulate thinking about various aspects that are related to

Gen-Xers and medicine compliance. Together the scenario and the image board were a

visual representation of the research we had done and it helped us figure out our next

steps.

Phase VI: Cultural Probes and Co-Design

The next part of our research was to create a kit that people could engage with and one that

would help them delve deeper into their daily routines and how medicines fit into these

schedules. The Co-Design activity focused on getting insights on reminders and distractions

that people associate with medicine compliance.

Phase VII: Usability Testing

Finally, we conceptualized an app that would assist people in taking medication on time

and conducted usability tests with 5 people. The aim of this test was to find out:

● If people would use an app for the purpose of medicine compliance

● If they have access to their phone while taking their medicines

● If incentives would motivate people to take their medicines on time

SET factors

Based on our preliminary research, we organized the information we gathered into a

number of Social, Economic and Technological factors.

Social Set Factors

There are many social set factors that apply to the issue of medical non compliance. First of

all, we categorized the landscape of Generation Xers as a social factor. We found that 62%

of people aged 35 - 49 years currently take prescription drugs. This same group of people

fills an average of 6 prescriptions per year. We also considered information about peoples

lifestyles to be social factors affecting medical compliance. Currently, members of

Generation X are of the age that many of them are entering the prime of their careers,

meaning they tend to have busy work schedules. On top of this, people of this age often

have started families, with one or more children. Finally, we considered some of the

consequences of medical non-compliance to be social factors. For obvious reasons, medical

non-compliance leads to unnecessary disease progression, and can be blamed for 125,000

deaths per year as well as 10% of all hospitalizations.

Economic Set Factors

Each year, medical non-compliance costs Americans over $100 billion. It is clear that the

economic impact of medical compliance is huge. Other economic set factors include

increasing prices of prescription drugs, as well as recent economic instability. Given the

current state of the economy and the high costs of healthcare in the United States,

affordability plays a large role in many people’s ability to fill prescriptions, and thus comply

with their medical recommendations.

Technological Set Factors

Other than the effectiveness and the adverse side effects associated with the drugs people

are prescribed, another important technological factor that influences medical compliance

is the connectivity we have become accustomed to. Our constant access to the collective

knowledge on the internet enables patients to conduct their own research related to their

medications. It also creates an opportunity to use peoples constant connectivity to help

them comply with their medication using reminders.

Landscape of current solutions

Currently there are a wide range of products and services in the market that aim to

improve medicine compliance. Differentiating factors include price, ease of use, and

portability. We divided these solutions into four categories: phone apps and alarms,

non-electric pillboxes, portable alarm pillboxes, and full-scale electronic pillboxes.

Apps and phone alarms

Apps and phone alarms are a low price and portable option. Apps range in cost from being

completely free to a few dollars. Most people already carry their phone with them, so this

option does not require any extra physical burdens.

Non-electric pillboxes

Non-electric pillboxes are extremely easy to use and also low cost. This is a great option for

users who want to keep things simple and would rather not set up or configure inputs,

alarms, and settings.

Portable alarm and vibrating pillboxes

Portable alarm and vibrating pillboxes require varying amounts of configuration and

typically cost between $10 to $50. They are a step up from a barebones pillbox in terms of

control and investment.

Full-scale electronic pillboxes

Full-scale electronic pillboxes have the largest footprint and also require the most

configuration. They can come with a hefty price tag of several hundred up to over $800.

These costly systems usually come bundled with software that link the device to your

computer for maximum control over your medicine regimen.

Questionnaires and Interviews

Questionnaires

Preliminary research showed that medicine compliance was indeed a problem in the

United States and our next step towards secondary research was to probe into the reality of

it.

We conducted a first round of surveys, which we distributed mainly to people visiting

Pharmacies and to friends and family. Through this exercise we were able to gather

nineteen filled surveys and the insights derived out of the same informed our interview

process. Of the twenty four people who took our survey, six were male and thirteen were

female. Furthermore, only 4 of the 6 males and 5 of the 13 women were within the ages of

34-50, amounting to a total of 9 Generation X participants.

The key insights gathered from our survey:

● Most people in Generation X have busy schedules and they tend to forget to take

their medicine on time.

● People have stopped taking a prescription early after seeing signs of getting better.

● A few people forgot whether they had taken their medicine.

● People are concerned about the side effects of taking medication.

The aim of the survey was to firstly, to find out whether people had medicine compliance

issues and secondly, to get an understanding of the reasons for these issues.

Interviews

For the next stage of secondary research, we conducted one-on-one interviews with

people from Generation X, probing further into the issue of medicine compliance. Of the

nineteen people who filled out our questionnaire, we were able to conduct in-depth

interviews with eight people, of whom five were from Generation X. The interview was

open-ended and sought to get the participant to talk about their concerns, schedules,

emotions, and the tools they use to help them take their medicines on time. As part of the

interview, we also had the participant recall the last time they had taken medication and

walk us through their process and environment at that point in time.

The results and takeaways from the interviews bolstered our initial insights in that they

elaborated on busy schedules, forgetting to take the medicine on time, concerns about side

effects and difficulties in making it a daily routine to take medicine.

Our biggest challenge during the course of this research was getting people to openly speak

about their compliance issues, however, we were able to gather enough data that could

inform us about the means and methods to use for Co-design and Cultural Probe activities

that followed.

Personas, Scenarios and Image Boards

Personas

Generation X was born between 1965 to 1980, so now their ages will be between 34 and 49

years old. They are typically autonomous and self-reliant, care about the balance between

work and life, but usually lead a busy and multitasking lifestyle. They are aware of the

importance of being healthy, and they’ll actively search and gather information about

health care.

Compared to baby boomers, Gen Xers are less responsive to TV and magazine health

advertisements, and more likely to consult online reviews.

As they advance in age, we believe that many Gen Xers are having troubles to adhere to a

regimented medical prescription for the first time in their lives. Due to the fact that this has

not been a part of their everyday lives up until this point, some Gen Xers may find it

difficult to follow their day to day prescriptions.

Jennifer

Female | 40 years old | Travel agent

She had 3-4 prescriptions in the past 12 months. Some lasted for 4-6 months, while others

just lasted for 1-2 weeks. She is aware of the importance of adhering to prescription, but

because of her busy schedule, she missed several doses and sometimes forgot if she had

taken the medicine. She once stopped a prescription earlier because of the side effect - it

caused a rash.

Robert

Male | 47 years old | Business person

He had 2 prescriptions in past 12 months. One of these medications was an antibiotic to

treat throat infection and he recently started taking cholesterol medication. Robert often

struggles to adhere to his medications. After a week of antibiotics, his throat was feeling

better so he stopped taking the medication to avoid side effects. He tries to stay compliant

with his cholesterol medication, but since it isn’t a part of his routine, he often forgets if he

has taken it.

Scenarios

To have a better understanding of Gen Xers' daily life, we interviewed people and let them

describe a typical day of them. A scenario could be: Gen Xer Jennifer woke up at around

7:30 am, because she was in a hurry, she skipped the morning dose and went to work. Her

meeting took her longer than expected, so she had to postpone the lunch time, as well as

the medicine time. At 2:00 pm, she had one pill to make up the dose at noon. She was less

busy in the afternoon, and she is able to get off from work almost on time now. When she

get into her car, she remembers that she needs to take the medicine, because everyday she

takes it after she enters the car.

Imageboard

To thoroughly consider the topic and get inspirations fast, we searched keywords:

medicine, doctor, patient, pharmacy, prescription, side effect, lifestyle, app, pillbox and so

on, organized them according to different categories, and then pinned them on a large piece

of paper.

The categories are:

● Apps and websites

● Devices and tools

● Side effects

● Organization of medicine

● Interaction with doctors and medicine

Through creating the image board, we gained an immersive experience of the topic

Medicine Compliance. It was a very inspiring process, since the more content we pinned on

the board, the more we could think of and add to the board. The image board acted as a

good visual reminder of the context and a good visual summary of what we had noticed and

studied within the topic.

The image board also helped us when we further developed the co-design kit. It was a great

ways to communicate ideas and scenarios fast and directly to the participants of our

co-design practice.

Cultural Probe and Co-design activities

From our secondary research and our initial interviews, we determined that there were

three main influences that cause medication noncompliance in members of Generation X:

adverse side effects, a busy schedule that doesn’t already involve taking medication, and

simple forgetfulness.

In order to gain more insightful information about medical compliance, we decided to

conduct a cultural probe and a co-design activity that addressed how busy schedules and

forgetfulness affect how compliant people in Generation X are with their medication. We

decided not to try to investigate the issue of side effects further, because side effects are a

result of the technology behind the medication, not the behavior of the people taking the

medication.

Cultural Probe

The culture probe activity that we had a number of members of Generation X complete was

designed to help us contextualize the activity of taking medication in busy schedule of

someone between the ages of 34 and 50 years. From our initial research and surveying

activities, we got feedback saying that a busy schedule and forgetfulness lead to

non-compliance, which caused us to wonder what it was about a person’s daily routine that

makes them forget to take their medication.

There were two parts to our cultural probe. The first part was a handout that included a

day long timeline and a number of sticky notes designed to encourage subjects to provide

information about their activities, feelings and attitudes throughout the day. For this part

of the cultural probe, we reached people in two ways. First, we reached out to a few people

we knew to be members of Generation X. We also did some “guerilla” research, by going

people in their places of work and asking them to respond to our cultural probe. By

reaching people in these two different ways, we were able to get more thought out

responses from those who knew we were going to be asking them about medical

compliance, as well as more candid responses from those who did not know we would be

approaching them with this activity.

Preparing sticky notes Subject completing cultural probe

There were a few things we were able to take away from this cultural probe activity. First

of all, three out of four of the people who completed the cultural probe noted that there

was a specific activity with which they always take their medication. One respondent

always takes her medication when she brushes her teeth, one always does when she is

getting dresses, and another is reminded to take his medication when he begins his

commute home at the end of the workday. The other person simply took her medication

when she had down time at work. We also found that people often feel rushed to take their

medication, because the prescribed time to take it does not mesh naturally with their daily

routine. For instance, one respondent noted that she often feels rushed on her lunch break,

because she has to have a hearty lunch with her medication, which she would normally

skip.

For the second part of our cultural probe, we asked a number of Generation Xers to

document the moment when they take their medicine by taking a picture of their

medication with a little context about where they are and what they are doing.

From this we hoped to understand exactly what is going on when someone takes their

medication. We found a number of important insights from this part of our cultural probe.

First of all, every person that responded had a glass of water or other beverage present

when they took their medication (presumably to help swallow their pills). The fact that

most people need access to water when taking their medication presents an important

restriction of their ability to take their medication. Also, we found that most of the pictures

were taken when relaxing at home. The one picture that was taken at work was of a person

who had a portable pill box that kept their prescriptions organized and easy to remember

at work.

Co-Design

The co-design activity we conducted aimed to encourage the people we talked to to think

about what helps them remember or causes them to forget to take their medicine. We

printed numerous photos of common items or situations a person might encounter

throughout the course of a day, and had them attach a color coded sticky note with a short

explanation written on it to the pictures that they felt were personal reminders and

distractions.

We gained a number of important insights from our co-design. The first was that

constraint on when and how to take medicine often make compliance very difficult. One

co-designer described how his medicine must be taken one hour prior to his dinner time

meal. That time happened to be during his commute, which meant he always had to be

prepared with his medicine and a water bottle accessible in his car so that he could wash

down the pill. He also noted that eventually, this helped him to remember his medication,

because once that became part of his commuting routine he was always reminded to take a

dose while driving, provided he remembered both the medication and a bottle of water.

Our co-design also confirmed a few hypotheses we had already developed. A number of

respondents confirmed that cell phone reminders were a good way to get their attention,

and that talking with their doctors about what medications they are taking and why helped

them feel confident about taking their medication.

Usability Testing

We decided to focus on an app for our usability test. During the creation phase, we put an

emphasis on both helpfulness and reliability. To ensure that the app is effective in helping a

user improve compliance, we incorporated an incentive system. To ensure reliability, we

incorporated an image recognition component to further validate compliance.

Flow on whiteboard

After determining the logic, flow, and wireframe of the app, we used POP (Prototyping on

Paper) to simulate how it would actually function.

With our prototype, we were able to engage five users to analyze their impressions and

motivations behind using our app.

Pros Cons

● Incentives

● Control over reminders

● Proof for pharmacies

● Can manage multiple medications

● Hassle to take pictures/focus on

meds every time

● May not have phone next to them

● May not need an app to remind if

they take only one or two meds

All users strongly agreed that an incentive system would make it more likely for them to

use our app and improve compliance. They suggested that discounts on prescriptions,

general pharmacy products, and groceries would be most desirable. Our app would also

make it easy for users to manage multiple medications and allow them to control the alert

settings to their likings. Because of our image recognition validation system, our app would

also act as proof of compliance to their pharmacies and doctors.

On the other hand, not all users were equally phone savvy. Even the users that use smart

phones frequently mentioned that it would not always be convenient to have to access

their phone during medicine intake. Furthermore, this app loses appeal if the user only has

one or two medications to track.

Through usability testing, we

also identified some flaws in our

prototype that would be

addressed in the next phase. The

‘Manage meds’ button and ‘Done’

button would loop until the user

acknowledged that they must hit

the option key. Furthermore,

‘Manage meds’ is ambiguous

terminology; users thought it would flow to a page where you can see all med alarms but it

actually flows to an add more prescriptions screen.

In addition, there is not a screen where users can see their alarms for the day, only a

calendar, which may not be helpful if they have to take more than one medicine per day.

Finally, we will add a comprehensive homepage in the next version. A few users found it

confusing when they had to find the ‘calendar’ and alarms. One person suggested that there

could be three different buttons for calendar, medicine alarms, and settings.

Overall research and key insights

The entire research goes from secondary research to first-hand info collection and analysis,

follows “do”, “say” and “make” principles, and leads us to the concept of our app design.

Through the research, we got the following insights: For Generation X, the fast-paced

lifestyle is the major reason of noncompliance. We also found that the current solutions to

medicine noncompliance are straightforward (reminder + incentives) but ineffective.

MUST, COULD and SHOULD

MUST

An effective solution must targeting the key problems.

● take into account people’s busy schedules

● have a reminder included because the main reason for non-compliance is

forgetfulness

● be simple and intuitive to use

COULD

Keep looking for other factors that help the solution work better.

● include incentives such as coupons and vouchers to capture people’s interest

● be an electronic solution as most people in Generation X have access to phones and

are quite tech-savvy

SHOULD

Taking usability and other issues into consideration.

● have a fool-proof system which does not allow people to get incentives without

having actually taken the medication

● not be too cumbersome to use and should take no less than a minute or two if it is an

activity

Appendices

Questionnaire

Revised

Please find our online questionnaire at the following link:

https://docs.google.com/forms/d/1Md3tQ6_I2yD028cC0ZTKuFrMJTeLkQKzRgxOvVI71-I/

viewform?usp=send_form

First Draft

Medicine Compliance ­ Team 1 Questionnaire 

 Demographic information:  Which age group do you fall under:  

○ less than 34 years old ○ between 34 and 40 years old ○ between 40 and 45 years old ○ between 45 and 50 years old  ○ more than 50 years old 

 Gender:  Male / Female  Are you single?  Yes / No Do you have any kids? If so, how many?  Yes____ / No   Prescription Information:  Have you been prescribed medication in the past 12 months?  

○ Yes ○ No 

 If so, approximately how many have you been prescribed in the past 12 months?  ____________________________________________________ 

 Have you ever been prescribed more than one medication at a time? If so, how many?  

○ Yes, ______________ ○ No 

 What is the duration of your prescription? If you have multiple prescriptions, list all of them below.  ____________________________________________________   Adherence Information:  

1. In the past 12 months, have you (check all that applied):  

○ Not filled or refilled a prescription ○ Missed a dose of a prescription ○ Taken a lower or higher dose than prescribed ○ Stopped a prescription early ○ Taken an old medication for a new problem without consulting a doctor ○ Taken someone else’s medicine ○ Forgot whether you had taken a medication 

  

2. For the answers you checked in number 1, how often do you take those actions?  

○ Daily ○ 2­4 times a week ○ Weekly ○ 1­2 times a month ○ Once every several months ○ Once a year ○ Less than once a year 

  

3. For the answers you checked in number 1, how much did the following reasons influence the actions you took regarding your medication? 

 Lack of time or busy schedule  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential  Concerns about an undesirable side effect  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential 

 Cost  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential  Forgot which ones to take  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential  Unclear instructions  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential  Cultural beliefs  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential  Did not believe the medication was effective  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential  I believed had recovered from my condition  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential  Other:__________________________  

No influence 1 ­­­­­­­­­­­­­­­­­­­­­ 5 ­­­­­­­­­­­­­­­­­­­­­ 10 Highly influential   If you would like to aid us further in our study by participating in a short interview in the future, please  provide us with your name preferred method of contact:  Name: ___________________________ Email: ____________________________ Phone: ___________________________ 

Pre-Interview Screening Questionnaire

Medicine Compliance Questionnaire  

All info collected is only for Carnegie Mellon University research purposes. All of your answers will be kept anonymous and confidential. 

 

Which age group do you fall under? ❏ Under 34 ❏ 34 ­ 39 ❏ 40 ­ 44 ❏ 45 ­ 49 ❏ 50+ 

What is your occupation? _____________________________ Have you been prescribed medication in the past 12 months? 

❏ Yes ❏ No 

In the past 12 months, have you (check all that applied): ❏ Not filled or refilled a prescription ❏ Missed a dose of a prescription ❏ Taken a lower or higher dose than prescribed ❏ Stopped a prescription early ❏ Taken an old medication for a new problem without consulting a doctor ❏ Taken someone else’s medicine ❏ Forgot whether you had taken a medication 

Interview Guide

Medicine Compliance ­ Team 1 Interview Guide 

 Intro: Hello, my name is (name 1) and this is (name 2).  We are students at Carnegie Mellon University, working on a research project looking into the influences surrounding medical compliance.  Thank you for being willing to participate in our research.  The following interview should only take a few minutes, and all of your responses will remain anonymous. However, if any of the questions make you uncomfortable, or you would prefer not to answer, just let us know and we will move on.  (We will administer a brief questionnaire prior to the interview.)  

● Please describe what Medicine Compliance means to you. ○ If they have trouble, decribe: 

■ Not filled or refilled a prescription ■ Missed a dose of a prescription ■ Taken a lower or higher dose than prescribed 

■ Stopped a prescription early ■ Taken an old medication for a new problem without consulting a doctor ■ Taken someone else’s medicine ■ Forgot whether you had taken a medication 

 ● On a scale of 1­10 (10 being very important), how important is it to you to take your 

medication as prescribed? ○ Why? (Try to draw out info about education, past experiences) 

 ● Do you ever find it difficult to comply with your medical prescriptions? 

○ Can you describe a time recently when you were non compliant? ○ What was the reason? Possible Reasons: 

■ Lack of time or busy schedule ■ Concerns about an undesirable side effect ■ Cost ■ Forgot which ones to take ■ Unclear instructions ■ Cultural beliefs ■ Did not believe the medication was effective ■ I believed had recovered from my condition 

 ● Do you use any tools to help you adhere to your medical prescriptions or does 

someone help remind you to take your medicines? ○ Do you find this assistance adequate? 

 ● What are your major concerns about the medication you are having to take? 

○ Do you think it doesn’t help you? ○ Are you worried about side effects/have you had any side effects? ○ Is cost a concern? 

 ● How much do you know about your medicine? What did your doctor tell you about it? 

Do you use other channels to get the info you need? ○ Did your doctor include you when deciding your treatment? 

 ● What do you like/hate about the medicine you are taking now? 

 ● Recall the last time you took your medicine. What were you doing before and after you 

took the medicine? What happened during the process of taking the medicine?  

● Can you think of any other reasons people do not adhere to their medical prescriptions? 

 Use probes as needed. These include: • Would you give me an example? 

• Can you elaborate on that idea? • Would you explain that further? • I’m not sure I understand what you’re saying. • Is there anything else? 

References

Health, United States, 2013 

Adherence to Long­Term Therapies: Evidence for Action 

Medication Adherence in America: A NATIONAL REPORT 2013 

https://hpi.georgetown.edu/agingsociety/pubhtml/rxdrugs/rxdrugs.html 

http://www.mts­mt.com/Why_MTS/Medication_Adherence_Resources.aspx