Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults

Abstract

Background: Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use.

Objective: This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics.

Methods: Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit.

Results: Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to "Good" to "Excellent" usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians.

Conclusion: Consumer-facing technology can be a low-cost, scalable intervention to improve older adults' medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change.

Keywords: Anticholinergics; Behavioral informatics; Digital health (eHealth); Human factors engineering; Information technology; Medications; Mobile health (mHealth); Patient safety; Shared decision making; User-centered design.

Fig. 1.

Study design.

Fig. 2.

Example screen captures from the Brain Buddy application.

Fig. 3.

Screen captures of Brain Buddy education screen and custom-made educational videos.

Fig. 4.

Attitudes and self-reported behaviors (left) and physician confirmation (right). A post-visit report could not be collected from the participant’s physician in six cases.