DESIGNING REMINDERS THAT

WORK

MARIA WOLTERS UNIVERSITY OF EDINBURGH @MARIAWOLTERS (WITH COLLABORATORS FROM UNIVERSITIES OF EDINBURGH, GLASGOW, AND STRATHCLYDE

AND QUEEN MARGARET UNIVERSITY)

THE PROBLEM: FORGETTING

• Our ability to remember to do things (prospective memory) declines with age

• Reminders help, but only if they can be understood

• Perceptual abilities are affected by age, work history, illness, …

• And forgetting is not a bug - it’s a feature

WHAT IS THE SOLUTION?

• Empower people to support their own memory!

• We need to:

• Co-design with people

• Focus on ability

• Provide diverse options

• I will focus on hearing as that is my specialty

CO-DESIGN

WHAT DOES CO-DESIGN COVER?

• People know what works for them (metamemory: knowledge about one’s memory abilities)

• People have strong modality preferences that are independent of their actual ability (McGee-Lennon, Wolters, and Brewster, 2011)

• If they don’t like it, if it’s stigmatising, or if it threatens their identity, they won’t use it.

STIGMA

HABITS AND CONTEXT

• Routines and environments are powerful cues (McGee-Lennon, Wolters, and Brewster, 2011; Stawarz et al, 2014; Wolters 2014)

• Reminders work best when they build on habits and context cues

• In fact, when tested in real life, older people can remember to do things as well as younger people … (Rendell and Craik, 2000)

FOCUS ON ABILITY

RELEVANT ASPECTS OF HEARING ABILITY

• For a successful auditory reminder, people need to

• perceive (can hear all aspects of the signal required for identification)

• understand (what needs to be done)

• act (even after distraction)

• Parallel tasks (cooking, reading, walking) may be additional distractor

RELEVANT DIMENSIONS OF COGNITIVE ABILITY

• Information processing speed How quickly can new information be analyzed and integrated?

• Working memory short term storage for information processing

• Metamemory what do I find difficult to remember?

• Fluid intelligence, e.g. reasoning, planning Making sense of a message, making plans

• Crystallised intelligence, e.g., semantic memory what do the words mean?

SOURCES OF INFORMATION ABOUT ABILITIES

• Relevant sciences (cognitive psychology, audiology, …) and experimental results

• Epidemiology / Large Data Sets

• English Longitudinal Survey of Ageing has data on health AND social / economic factors (see e.g. Wolters/Hanson/Moore 2011)

• Lothian Birth Cohort illustrates effects of life style and environment http://www.lothianbirthcohort.ed.ac.uk

• Inclusive Design Toolkit (Cambridge) condenses some epidemiological data http://www.inclusivedesigntoolkit.com/betterdesign2/

ACTIVITIES OF DAILY LIVING AND SOCIOECONOMIC DATA

THE GOLD MINE OF ELSA

• assessment of (independent) activities of daily living and self-reports show the extent of perceived disability and handicap

• socioeconomic data show

• resources people have access to (or lack thereof)

• web of stakeholders and responsibilities

EXPERIMENTAL STUDY: MEDICATION REMINDERS

• For medication reminders, it’s best to use actual names (too much difference in appearance for generics)

• There are limits to what people can usefully remember. Older people can’t recognise sequences of four medication names if they’ve been distracted after hearing them (Wolters et al, 2015), even if

• all they need to do is pick out their names from a list

• their function was explained (and function is given on list)

• Reminders for morning pills or afternoon pills would work much better

SUPPORT OPTIONS

REMINDERS DON’T EXIST IN A VACUUM

• Implementing reminders involves people, spaces, perceptual constraints, aesthetics, organisations

• Example: A woman who lives with her partner, mother, and children uses an automatic pillbox that beeps loudly when it is medication time. The pillbox is in the bathroom off the master bedroom. It is quite fugly. The woman needs to remember to refill her meds on time, which involves a call to the doctor and a trek to the nearest chemist.

IMPLEMENTATION CHOICES: MEDICATION

• Choice 1: Phone or text people with a reminder. Requires central service that can be maintained by IT and interface to people who set reminders

• Choice 2: Pharmacy-led services. Requires pharmacist to assemble relevant medication by day and time in dosette dispenser. Pharmacist can be simulated by patient, partner, or carer working with a standard issue dosette box and a pile of pills.

• Choice 3: Combination of the above, with more simple reminders

• Choice 4: Strategically place pills where patient will be when they need to be taken

TECHNOLOGY CHOICES: SYNTHETIC SPEECH

• Synthetic speech has become far more intelligible, even in noise

• Disadvantages:

• can sound like a computer

• Advantages:

• incredibly flexible - you can teach it any word

• easy to switch accents and speakers

• easy to personalize messages

• inexpensive

MANY KINDS OF (COMPUTER) SPEECH

• Look for an acceptable vocal personality

• People find an accent to which they are accustomed easier to understand - don’t trust popularity surveys!

• Clear articulation, maybe even Lombard speech, which is recorded while speaker hears noise

• Use pauses and emphasis to highlight information

• Let the person who will hear the reminders choose the voice, not their carer

• Questions?

Maria Wolters, mariawolters.wordpress.com

@mariawolters, maria.wolters@ed.ac.uk

When co-designing reminders,

• focus on abilities what is preserved? How do people compensate?

• support different options to support people’s identity

This will make it more likely that reminders will work.

DONEC QUIS NUNC

REFERENCES

• Rendell, P. G., & Craik, F. I. M. (2000). Virtual week and actual week: Age-related differences in prospective memory. Applied Cognitive Psychology, 14, S43–S62.

• McGee-Lennon, M. R., Wolters, M. K., & Brewster, S. (2011). User-Centred Multimodal Reminders for Assistive Living. In CHI ’11: Proceedings of the 29th international conference on Human factors in computing systems.

• Stawarz, K., Cox, A. L., & Blandford, A. (2014). Don’t forget your pill! In Proceedings of the 32nd annual ACM conference on Human factors in computing systems - CHI ’14 (pp. 2269–2278). New York, New York, USA: ACM Press. http://doi.org/10.1145/2556288.2557079

• Wolters, M. K. (2014). The minimal effective dose of reminder technology. In Proceedings of the extended abstracts of the 32nd annual ACM conference on Human factors in computing systems - CHI EA ’14 (pp. 771–780). New York, New York, USA: ACM Press. http://doi.org/10.1145/2559206.2578878

• Wolters, M. K., Johnson, C., Campbell, P. E., DePlacido, C. G., & McKinstry, B. (2014). Can older people remember medication reminders presented using synthetic speech? Journal of the American Medical Informatics Association, 22(1), 35–42. http://doi.org/10.1136/amiajnl-2014-002820

DONEC QUIS NUNC

PICTURE REFERENCES

https://funnyoldlife.wordpress.com/tag/hearing-aid/http://38pitches.com/hearing-aids/http://www.kissmywonderwoman.com/2014/12/on-hearing-loss-hawkeye-and-superheroes.htmlhttps://www.pinterest.com/aaahearingaids/hearing-humor/https://en.wikipedia.org/wiki/Brad_Pitthttps://en.wikipedia.org/wiki/Austin_Powers_(character)