University of Twente Student Theses


Design and evaluation of persuasive feedback-inhaler to enhance medication adherence among COPD patients

Kingma, M. (2016) Design and evaluation of persuasive feedback-inhaler to enhance medication adherence among COPD patients.

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Abstract:Background: Chronic lung patients often use inhalers incorrectly, which is a significant problem due to diminished therapeutic effects. Consequently, it can result in inflammations, exacerbations, hospitalization and a lower quality of life. Furthermore, it leads to high medical costs. Therefore, it is important to support patients in using inhalers properly. Current technological developments aimed at supporting inhaler use, mainly focus on measuring frequency of use, reminding patients to use the inhaler and monitoring of use in order to send data to healthcare professionals. These developments lack real time support of patients during inhalation. Objective: The purpose of this study is the design and evaluation of a smart inhaler prototype, which integrates smart sensor technology and persuasive feedback in inhaler medication. The main objective is to define requirements and persuasive features that smart sensor technology needs to meet in order to provide reliable, valid and usable support for chronic lung patients as well as for the healthcare professionals. This study presents the outcomes of the user evaluation, among prospective users of the new smart inhaler and personalized portal, called the Feedback-Inhaler. Methods: A holistic framework known as the CeHRes roadmap is applied as a guideline for the development of persuasive health technology. Within prior research the first contextual inquiry phase is conducted. In-depth interviews and contextual observations are carried out with twelve Dutch chronic lung patients to gain insights into the current practices and needs for smart sensor technology and inhaler medication. Persona’s and use-case scenarios are developed based on the results of the contextual inquiry, as well as requirements and persuasive features within the value specification phase. After that, in the design phase, a first low-fidelity prototype of the smart inhaler and personalized portal is developed. The new feedback-inhaler provides real-time coaching during inhalation, as well as additional coaching via a portal. Within this study, a formative scenario-based user evaluation of the first prototype is carried out with chronic lung patients (age 41-78, eight male, six female) and healthcare professionals (four pulmonologists, one respiratory nurse and one medical microbiologist). Each participant received a short scenario-based introduction on the purpose of the study, as well as on how the new feedback-inhaler and patient portal for coaching works. Scenarios are based on medical inhalation protocols and are validated by a respiratory nurse. User evaluation sessions are video recorded and analysed. Results: User evaluation results indicate that patients have a positive view towards the feedback-inhaler. The most important guidelines to improve the feedback-inhaler according to them are: a) the type of real-time feedback modalities should be optional, b) guidelines to relax should be provided, c) the portal should be simplified, and d) notifications should be displayed via smartphone. The healthcare professionals indicate that the new feedback-inhaler is clinically relevant. Guidelines for improvement according to them are: a) patient data should be linked to hospital codes; b) patient data should be presented via one overview, and c) feedback should have a positive approach. Conclusions and Future Work: All participants are positive about the first feedback-inhaler prototype. In general for a feedback-inhaler to be succesful, it should be simple and provide praise and rewards. Furthermore, real-time feedback concering the proper maintenance of inhalers, the duration of the inhalation and guidelines to relax during inhalation should be added. The personalized portal for patients must enable users to self-monitor their inhalation technique. Via the personalized portal for healthcare professionals the data concerning the inhalation technique of patients must be available rapidly and presented in one clear overview. Healthcare profesionals have a positive attitude towards implementing the feedback-inhaler. Main conditions are that the technology must be available for all patients and type of inhalers and instructions about the technology must take place outside of the consultation room. Future work should aim at finetuning the feedback-inhaler. By means of a summative evaluation the effect of the technology should be examined.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
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