Performance-Based Usability of Medication Adherence Technologies Among Older Adults With Diverse Capabilities:...

Medication adherence technologies (MATs) offer innovative solutions to support older adults in managing complex medication regimens, yet usability challenges can prevent their successful use. Older adults often face cognitive, physical, sensory, motivational, and environmental barriers, which can influence how they interact with these devices. Therefore, performance-based usability testing is essential for identifying usability issues.

This study aimed to evaluate the performance-based usability and user experience of 13 MATs among older adults with diverse capabilities.

A prospective mixed methods design was used, with 96 participants aged 60 years and older testing smart and electronic MATs using cognitive walkthroughs and predefined usability tasks without formal training to simulate first-use conditions. This manuscript focuses specifically on the performance-based usability metrics collected as part of the mixed methods study. Validated tools, including the Self-Medication Assessment Tool (SMAT), Daily Living Tasks Dependent on Vision (DLTV), Whisper Test, Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and Martin and Park Environmental Demands (MPED) Questionnaire, were used to assess individual barriers. Poisson generalized estimating equations (GEE) was used to determine predictors of unassisted task success and error rates while accounting for repeated observations.

A total of 96 participants (mean age 75.1, SD 7.7, range 61-95 y) were included, with 37.5% (36/96) male and 62.5% (60/96) female. Poisson GEE models identified significant predictors of unassisted task success rate, including cognitive score (P<.001), physical score (P<.001), vision score (P<.001), motivational score (P<.001), and lower environmental busyness (P=.049). Female sex was associated with a 9% lower success rate (P=.002). Predictors of total error rate included age (P=.02), sex (P≤.001), physical score (P≤.001), vision score (P=.004), DLTV vision score (P=.01), MPED routine score (environmental; P=.05), and interaction between physical score and sex (P=.004).

Both device design and user characteristics strongly influence the usability of MATs. Performance-based evaluations provide actionable findings for user-centered design and selection, guiding manufacturers and health care providers toward developing and choosing accessible technologies that could improve medication adherence among older adults.