A Human Factors Evaluation of Blood Pressure Monitors for Use in the MEDSReM 2.0 System
TimeThursday, April 152:01pm - 2:02pm EDT
DescriptionBackground: The MEDSReM-2 (Medication Education, Decision Support, Reminding, and Monitoring System 2.0) project goal is to advance the design of a system to improve adherence to hypertension medications among adults aged 65 and older. The MEDSReM-2 system is an integrated mobile app and web portal that includes medication information and reminding; education about adherence and healthcare strategies; decision guidance for missed doses; and tracking of adherence and blood pressure (BP) over time. The system is theory and evidence-based, building on the Multifaceted Prospective Memory Intervention (Insel et al., 2016, MEDSReM R21). The MEDSReM version 2.0 will incorporate wireless BP measurement to foster hypertension self-management and medication adherence. The first step to this integration was to identify a suitable wireless BP monitor with minimal usability challenges for older adults. Older adults generally have less experience with technology; moreover, age-related changes in perception, cognition, and movement control may impose usage challenges (e.g., Czaja et al., 2019; Morey et al., 2019).
Methods: To identify a suitable BP monitor the research team first conducted a comparative analysis of 16 monitors that are widely available for consumer use. Nine of the BP monitors were compatible with iOS – a requirement, since the MEDSReM-2 app will be available as iOS only during the study. Initially the OMRON Evolv (“Evolv”) seemed to be the best choice because positive online reviews for usability and accuracy and familiarity from previous use of wired Omron BP monitors. Upon further review, the process to upload data from the Evolv to the MEDSReM-2 app included an additional step of opening and synchronizing data via the paired mobile app that complicated the use of a BP monitor. The Withings BPM Connect (“Connect”) was identified as an alternative choice due to a more direct data synchronization process. Eight members of the MEDSReM-2 research team conducted an informal cognitive walkthrough of the Connect and the Withings Health Mate mobile app. Evaluators were given instructions asking them to take the perspective of an older adult user and to provide feedback on three tasks: 1) unboxing and initial impressions, 2) taking a BP measurement using only the Connect, and 3) pairing the Connect via Bluetooth to the Health Mate app, taking additional BP measurements, and viewing the results on the Health Mate app.
Findings: First impressions of the Connect were positive (8/8 evaluators). Evaluators noted the Connect was “well-built”, “neat, stylish, compact, and attractive”, and “minimalistic”. A general negative comment (4/8) was that the minimalistic design (one button to control all functions, a multipurpose dot matrix type screen for feedback and results) might be confusing to older adults unfamiliar with health devices or those with cognitive decline and difficult to read for those with vision deficits. Half of the evaluators (4/8) found the instructions easy to follow, but 2/8 noted the small type and dark kraft paper might pose challenges for some users to read. Most evaluators (6/8) had no difficulty charging the Connect via the supplied USB cable. However, three evaluators noted that not all older adult users will be familiar with this type of cable or have a computer or wall charger needed for charging. The Connect was found to be easy to position on the arm (6/8), and 5/8 found the measurement process was easy to follow and the display easy to read. Most (6/8) found it clear when the measurement process was complete. Half of the evaluators (4/8) had difficulty pairing the Connect to the Health Mate app. These evaluators noted a lack of printed instructions and the Health Mate app defaulting to a WiFi connection versus Bluetooth. Most evaluators (6/7) reported no issues synchronizing data from the Connect to the app. Evaluators found using the Connect, synchronizing measurements to the Health Mate app, and downloading the app to be the easiest to use tasks, recorded on a five-point Likert scale (1 = very difficult, 5 = very easy). The most difficult task was pairing the Connect to the Health Mate app (mean = 3.64, SD = 1.35).
Conclusions: There are a number of wireless BP monitors on the market. We had specific requirements for the MEDSReM-2 system, and the Withings BPM Connect seemed to be a viable option to integrate with our system. Our user evaluation, with special consideration for older users, yielded valuable insights. First, the minimalistic design of the Connect may pose challenges to older adults unfamiliar with modern health devices. The lack of dedicated buttons that are clearly labelled for each function, and use of a dot matrix display showing the device status and measurement results, may increase the likelihood of use error or confusion. These and other usability issues may be mitigated for the MEDSReM-2 system by assisting users with pairing the Connect, providing them with legible instructions and technical support, and including USB wall charger. These steps will be pilot tested with older adults to ensure improved usability of the Connect prior to the randomized trial. These findings have broader implications for health technology design for older adults.