EXECUTIVE SUMMARY

A new program using smart speakers could function as a birth control and other medication reminder, improving adherence, according to the authors of a recent study.

  • Investigators followed college-age women on birth control for two months, giving them three reminders a day through a smart speaker to take their medication.
  • Some participants found the voice-based reminder made them feel more accountable to take their medicine.
  • Some problems arose in voice recognition and skill name similarities.

The results of a recent study revealed that young women like a birth control pill reminder from a virtual home assistant or smart speaker.1

“I’ve been working with trying to see what devices have the potential to help people with health management,” says Cynthia L. Corbett, PhD, RN, FAAN, SmartState endowed chair in clinical effectiveness research/chronic care management and professor at the University of South Carolina College of Nursing.

One idea was to use a smart speaker like Amazon Echo, Google Home, or Google Nest as a medication reminder system. “For the Amazon Echo program, our team worked on developing a skill/app that reminds people to take their medicine,” Corbett says.

Researchers decided to test the app on college undergraduates who were taking oral contraceptives. Initially, they were planning to test it with an older adult population, but one of the undergraduate researchers suggested asking the young women on birth control who are more tech savvy and would be less likely to become frustrated.

“My undergraduate student assured me that women who take oral contraceptives have a hard time remembering to take them,” Corbett explains. “We decided that was a good idea, so we recruited women who are college students to use our new app using Amazon Echo Dot.”

They recruited women through flyers, personal websites, and social media announcements. The young women who responded visited the lab and set up their phone and Amazon Echo Dot with the medication adherence skill that the researchers named MedBuddy, Corbett explains.

“It gives them three reminders at whatever reminder time they want to do it,” she says. “If you connect the Amazon account on your phone, you can get [reminders] on your phone or on the Dot at the same time.”

Students tested the app for two months, around the start of the COVID-19 pandemic. Because students were sent home, not all were able to continue consistently using the app. Some left their smart speaker at their school apartment.

“We were still able to finish the study, and they really seemed to like it,” Corbett says. “I was a little bit surprised they liked it as well as they did.”

For example, some students said that the voice-based reminder helped them feel more accountable to taking their medication than if they just had an alarm on their phone. “People tend to personify voice-based speakers, so they feel more accountable to them,” Corbett says.

The Amazon Echo uses the name Alexa. “It sounds like a person’s name and it responds in a conversational manner,” Corbett explains. “We were trying to design it to seem like you were having a conversation with somebody.”

It also is possible that a voice-reminder system is harder to ignore. “You can do other things with the smart speaker, like ask it to play music or ask it for information,” Corbett says. “It becomes more like another presence or human-like device that people feel accountable to [respond to].”

The intervention’s three reminders were designed to make it difficult to ignore the medication prompt. The first reminder would say that it was time to take the medication. Then, it would go off again 15 minutes later, and for a third time 15 minutes after that.

If a woman wanted to stop the alarm because she took her pill, she would say, “Alexa, open MedBuddy,” and “Tell MedBuddy I took my medicine.”1

The device would ask what time the woman took the medication and record her answer on a calendar. Then, MedBuddy would stop sending reminders, Corbett says.

As researchers developed the app, they found the name MedBuddy caused problems with the voice recognition. They changed the name to PillMinder and received fewer complaints.

“One of the things we learned from the study was that sometimes they would have to tell Alexa to tell MedBuddy several times,” Corbett says. “We found that there are a lot of skills on Amazon Echo that are called something buddy, so we needed to change the name of the skill.”

One woman enrolled in the study stopped responding to the MedBuddy app because she found it frustrating that it would not understand her. But, she continued to use the reminders to take her birth control pill.

“Overall, I think about two-thirds of the women said they would continue to use it if given the opportunity,” Corbett notes. “We asked people, at baseline, how often they missed taking their contraceptives, and then we asked them again at the end of the study. When we checked the Likert scale, they said they improved [adherence] overall.”

Investigators have not yet made this skill publicly available on Amazon, and it may be a year before they do. They want to study it further and make sure the app is working as well as possible.

“If people want to use something now, both Amazon and Google have a reminder system where you can tell [the smart speaker] to remind you to take your medication every day at a certain time,” she explains. “It can be put on your phone, but it won’t have the three reminders, which is something that our people liked.”

People could set up their own system with three reminders at separate times.

“They could definitely set it up just using the basic features that these smart voice-activated speakers currently have,” Corbett says. “Based on our results, I think people might like it.”

REFERENCE

  1. Corbett C, Combs EM, Chandarana PS, et al. Medication adherence reminder system for virtual home assistants: Mixed methods evaluation study. JMIR Form Res 2021;5:e27327.