Medicine Compliance final report

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
○ 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

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