It was a tiring experience, after a few months struggling with both medical and programming related subjects, finally, last week, we have successfully presented our own research at the Medical Undergraduates Annual Scientific Research Meeting (MUASRM) which was held in the Faculty of Medicine, Universiti Kebangsaan Malaysia. There are 18 oral presentations and 34 poster presentations and I must say, each and every single one of them is unique and interesting; if I were to be a judge, it will be difficult for me to decide, which one can be regarded as the best research among all others.
I've written two articles regarding my research in the past and today I would like to tell you relevant findings that we have found. The name of our prototype medication is Take Your Meds, this particular application is yet to be made available for download in any of the smartphone repos. I know the name is quite typical but that's the best that we can think of prior to the MUASRM. We have been allocated to a certain percentage of financial aids provided by the University Research Grant, so in the future, the name of the application might be different than it is now.
Like I have mentioned during my presentation, smartphones have been regarded as one of the most important tools which are capable of simplifying activities in our everyday life. Malaysian Communication and Multimedia Commission has published a report regarding smartphone penetration in Malaysia and in 2017, it was estimated that there are roughly 13 million users (75%) who were using smartphones among all of the available mobile phone users population.
Take note that, when I'm using the word "mobile phones", I'm referring to both the classic keypad mobile phones and smartphones. It's difficult to see the significance regarding the number of people who were using smartphones in the report published by the MCMC but between the year of 2012 and 2013, we have seen a transition of 2.6 million Malaysian from the classic keypad mobile phones to smartphones; it equals an increment percentage of 16% smartphone penetration.
According to a report published by Ericsson, one of the most published networking and telecommunication companies, it is estimated that by the year 2020, 90% of the global population would own smartphones; this increases in number can be attributable to a significant stride in the global trend. I mean, people were using iPhones, various kind of Android phones, there are a lot of advertisements related to all of these phone models, it's like a raging propaganda, asking people to use a smartphone as part of the social acceptance ritual.
If the majority of people in the social circle/general population/global population were to use smartphones, then this tool can be regarded as valuable; it can be used to monitor various activities, achieving certain objectives etc. and my focus on this research is to maximise the uses of smartphones in optimising health of the global population. Medical reminder applications might seem redundant, but up until now, there hasn't been any which has been recommended as a standard for the uses of a certain population. Our research focused on the uses of our very own prototype medication reminders in the local context.
How Many Medication Reminders Are There?
From various literature, there are some disparities in terms of the number of medication reminders available in the smartphone market but a study conducted by Santo K et al in 2016 has found that there are 272 medication reminders which can be downloaded either for free or you have to spend some dollars to use it. It's quite a huge number but the majority of them received low stars rating or abandoned by their own developers thus they were categorised as low-quality applications. It is not easy to make a medication reminder works or suit to users' demands but somehow we were trying to make it work by integrating basic and novel functions into a single prototype.
In 2015, Ashley et al studied various types of medication reminders and he found that, practically, the majority of medication reminders provide the same functions, alas some of them have to be paid. There are a few medication reminders which are free and comprises of a variety of high-quality functions in the smartphone market but unless companies which are responsible for inventing them have a stable financial status or support from various organisations, then one of the ways to generate income so that it can be used to provide mobile phone applications maintenance support (bugs fix etc.) is to put a certain price to be paid by users.
The problem with this particular model is approximately 90% of users wouldn't want to pay anything for using a medication reminder. They are motivated to use them but not to pay for using them.
The Concept And User Acceptance Of The Prototype
The idea behind the concept implemented to this particular prototype is to provide some sort of digital evidence instead of just reminding people to eat their own medication. I can't really publish the picture of the application here but basically, after the alarm was triggered by a specific time, users would be brought to the prototype camera application. They have to capture the medication that they wanted to take and the image would then be recorded. At the same time, they were pressing the capture button, the action would be recorded in the user's log (time, date).
The user's log would serve as the first digital evidence of the patient's compliance and the image captured would serve as the second. If patients were found to be compliant with their medication (according to logs) but their condition was still deteriorating, then physicians or anyone related can check the images. Sometimes, people use the medication in a wrong manner. Elderly population, for example, have to take a cocktail of medication related to their chronic condition and it can be quite confusing for them regarding which one should be taken twice a day, thrice a day etc. In another perspective, this application can serve as a reference for clinicians to determine whether patients need pharmacological counselling or they need to modify a certain aspect of their own medication (change the dose, or frequency or the medication itself).
Throughout the beta testing period, users encountered a few bugs related to their own smartphone models. Initially, we thought it will be easier to make an android application but we failed to notice that there are a few models of android phones which possessed a unique security construct. Unless they were disabled manually, it will interfere with the basic function of the application; the alarm itself. Phone models like Oppo, Samsung and Huawei have been quite a pain for us to manage but I'm sure in the future, we would be able to find an effective way to make it work.
The table above contained information regarding the Beta Test pertaining to our prototype application. As you can see, the majority of our users are elderly. It's not easy to find elderly people who are motivated to participate in our study as quite a number of them are not keen to use smartphones. According to Jennifer K. Carroll et al, there are 4 characteristics of people who usually frequent health-related mobile phone application:
- Young
- Financially stable
- High level of knowledge
- High income
However, we need to focus on people who were using a number of medications to measure user acceptance thus elderly population would be the way to go. There are 3 aspects which have to be evaluated by users at the end of the user acceptability test; they were:
- Graphic attributes
- Functionality Attributes
- User Perspective Attributes
Users have to give a score to a specific domain, 1 being very unsatisfied and 5 being very satisfied.
In the graphics attributes, most users gave a score of 3 to the visually appealing category. Although the score of 3 is termed as "moderately satisfied", we can safely assume that the level of user's satisfaction is not sufficient; in another word "it was so-so". Honestly, our prototype is not that good looking, after all, it is only a prototype and it was designed by inexperienced developers (medical students and a PhD student who have no prior experience in mobile apps programming). The score 3 which was given by users can be justified by a study which was conducted by Santo K et al which has identified attractiveness as one of the most important features of a mobile application to retain its users in the long-term period.
What about the functionality? The majority of users gave a score of 3 to both the functioning effectively and easy and accurate category. This is attributable to bugs and problems encountered throughout the Beta testing period. It is not easy to commit yourself to a single application with a lot of bugs in it. In fact, an independent survey conducted by QualiTest (a software quality company) has found that 880 people out of 1000 participants would abandon their apps if they encountered bugs.
This is practically the result of the overall attributes. As our application seems to perform moderately in terms of its graphic and functionality, users are not so determined to use it on a daily basis or even recommend it to others. Interviews with our subject revealed that if we make a significant improvement in terms of the aforementioned categories which have been rated with a score of 3, they might be interested to test it out again.
The use and capture concept which was tested among all other users in this study was found to be quite useful in term of medical monitoring to improve users health. It will be much convenient for people who have to commit to a long-term or lifelong medication regime. It provides a two-way communication between patients and physicians which would make management to a certain disease much more convenience.
Future Study Recommendation
The first recommendation I would like to make pertaining to this study is for people to make a proper collaboration with professionals sparing unrelated people from unnecessary traumatic experience along the way. That being said, trying to manage your life as a medical student while learning about programming during the weekend can be quite difficult; not quite, extremely difficult. Allocating the appropriate amount of budget can be helpful as well, for example, in this study, we are expected to use RM5000 for everything but it is insufficient. We can't even use the money to rent a cloud storage and using enterprise cloud storage (Google Drive or Dropbox) can violate the user's right to privacy.
We were using developers Whatsapp as a theoretical cloud storage, which means, users have to send the captured image to us. Everything was done manually and it is quite difficult. Exploring the importance of cloud storage and automated function can enhance the effectiveness of this particular prototype. A few weeks before our presentation in MUASRM, we were able to contact people who were specialising in privacy and security of a mobile phone application. Unfortunately, we weren't able to implement it so maybe it can be implemented next.
The purpose of this study is to identify bugs, problems and to test the concept which was implemented in this prototype. This study has certainly proved that the concept is feasible and the prototype can be used as a medication reminder/monitoring application. Take a look at the tabulated form of the user's log below:
All of the users in our study have to take between 2-4 medications twice a day so they were expected to use the application 28 times in 14 days. All users used between 21-27 times for 14 days period except for user 8 which only used the application 15 times. This application would be able to capture patient's behaviour regarding their medication compliance but to measure the effectiveness, a validation study need to be conducted in the future with an appropriate number of subjects.
Oh yeah, by the way, we won the oral presentation category and I was awarded the best presenter.
With such an awesome start to my final year, I can feel it, 2019 would be my year to shine.
References: [1], [2], [3], [4], [5]
All images which are not cited below is my own image.
Images: [1], [2], [3], [4], [5]
