Abstract
Aging adults are impacted by pain. Technology can assist older adults with pain self-management while allowing for independence. The current usability study explored the use of voice assistant reminders for two pain self-management tasks in aging adults. Fifteen community-dwelling older adults with chronic pain and an average age of 65 years used the voice assistant for 4 weeks. Participants had moderate scores for pain severity (mean = 4.6 [SD = 2.3]) and pain interference (mean = 4 [SD = 2.6]). Voice assistant usability was above average (78 of 100). Median time to set up the Google Home Assistant profile was 5 minutes (SD = 7.5), with a median of asking for help two times. Pain self-management task reminders from the voice assistant were perceived as consistent, easy to set up, and helpful for accountability. Voice assistant reminders may be an option to help encourage a variety of pain self-management tasks in aging adults. [Journal of Gerontological Nursing, 46(10), 27–33.]
- American Geriatrics Society Beers Criteria® Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694
10.1111/jgs.15767 Crossref Medline, Google Scholar - Austrian J. S., Kerns R. D., Reid M. C. (2005). Perceived barriers to trying self-management approaches for chronic pain in older persons. Journal of the American Geriatrics Society, 53(5), 856–861
10.1111/j.1532-5415.2005.53268.x PMID:15877564 Crossref Medline, Google Scholar - Bangor A., Kortum P. T., Miller J. T. (2008). An empirical evaluation of the system usability scale. International Journal of Human–Computer Interaction, 24(6), 574–594
10.1080/10447310802205776 Crossref, Google Scholar - Bhattarai P., Phillips J. L. (2017). The role of digital health technologies in management of pain in older people: An integrative review. Archives of Gerontology and Geriatrics, 68, 14–24
10.1016/j.archger.2016.08.008 PMID:27584871 Crossref Medline, Google Scholar - Booker S., Herr K., Tripp-Reimer T. (2019). Black American older adults' motivation to engage in osteoarthritis treatment recommendations for pain self-management: A mixed methods study. International Journal of Nursing Studies. Advance online publication.
10.1016/j.ijnurstu.2019.103510 PMID:32169337 Crossref Medline, Google Scholar - Callejas Z., López-Cózar R. (2009). Designing smart home interfaces for the elderly. ACM SIGACCESS Accessibility and Computing, 95, 10–16
10.1145/1651259.1651261 Crossref, Google Scholar - Chodosh J., Morton S. C., Mojica W., Maglione M., Suttorp M. J., Hilton L., Rhodes S., Shekelle P. (2005). Meta-analysis: Chronic disease self-management programs for older adults. Annals of Internal Medicine, 143(6), 427–438
10.7326/0003-4819-143-6-200509200-00007 PMID:16172441 Crossref Medline, Google Scholar - Chung A. E., Griffin A. C., Selezneva D., Gotz D. (2018). Health and fitness apps for hands-free voice-activated assistants: Content analysis. JMIR mHealth and uHealth, 6(9), e174
10.2196/mhealth.9705 PMID:30249581 Crossref Medline, Google Scholar - Cipriani J., Conner K. (2019). New Echo Show 5? Everything you need to set up Amazon's smart speaker with a screen. https://www.cnet.com/how-to/new-echo-show-5-everything-you-need-to-set-up-amazons-smart-speaker-with-a-screen/ Google Scholar
- Cruise C. E., Broderick J., Porter L., Kaell A., Stone A. A. (1996). Reactive effects of diary self-assessment in chronic pain patients. Pain, 67(2-3), 253–258
10.1016/0304-3959(96)03125-9 PMID:8951918 Crossref Medline, Google Scholar - Dahlhamer J., Lucas J., Zelaya C., Nahin R., Mackey S., DeBar L., Kerns R., Von Korff M., Porter L., Helmick C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults – United States, 2016. Morbidity and Mortality Weekly Report (MMWR), 67(36), 1001–1006
10.15585/mmwr.mm6736a2 PMID:30212442 Crossref Medline, Google Scholar - Eaton L. H., Langford D. J., Meins A. R., Rue T., Tauben D. J., Doorenbos A. Z. (2018). Use of self-management interventions for chronic pain management: A comparison between rural and nonrural residents. Pain Management Nursing, 19(1), 8–13
10.1016/j.pmn.2017.09.004 Crossref Medline, Google Scholar - Eggermont L. H., Leveille S. G., Shi L., Kiely D. K., Shmerling R. H., Jones R. N., Guralnik J. M., Bean J. F. (2014). Pain characteristics associated with the onset of disability in older adults: The maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study. Journal of the American Geriatrics Society, 62(6), 1007–1016
10.1111/jgs.12848 PMID:24823985 Crossref Medline, Google Scholar - Gruber-Baldini A. L., Velozo C., Romero S., Shulman L. M. (2017). Validation of the PROMIS® measures of self-efficacy for managing chronic conditions. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 26, 1915–1924
10.1007/s11136-017-1527-3 PMID:28239781 Crossref Medline, Google Scholar - Hadjistavropoulos T. (2012). Self-management of pain in older persons: Helping people help themselves. Pain Medicine, 13(Suppl. 2), S67–S71
10.1111/j.1526-4637.2011.01272.x PMID:22497750 Crossref Medline, Google Scholar - Hertzog M. A. (2008). Considerations in determining sample size for pilot studies. Research in Nursing & Health, 31(2), 180–191
10.1002/nur.20247 PMID:18183564 Crossref Medline, Google Scholar - Hoy M. B. (2018). Alexa, Siri, Cortana, and more: An introduction to voice assistants. Medical Reference Services Quarterly, 37(1), 81–88
10.1080/02763869.2018.1404391 PMID:29327988 Crossref Medline, Google Scholar - Kaye A. D., Baluch A. R., Kaye R. J., Niaz R. S., Kaye A. J., Liu H., Fox C. J. (2014). Geriatric pain management, pharmacological and nonpharmacological considerations. Psychology & Neuroscience, 7(1), 15–26
10.3922/j.psns.2014.1.04 Crossref, Google Scholar - Kinsella B. (2019). More than half of consumers want to use voice assistants for healthcare – New report from Voicebot and Orbita. https://voicebot.ai/2019/10/29/more-than-half-of-consumers-want-to-use-voice-assistants-forhealthcare-new-report-from-voicebot-andorbita Google Scholar
- Koetsier J. (2018).Amazon Echo, Google Home, installed base hit 50 million; Apple has 6% market share, report says. https://www.forbes.com/sites/johnkoetsier/2018/08/02/amazon-echo-google-home-installed-base-hits-50-million-apple-has-6-market-share-report-says/#7f301975769c Google Scholar
- Lau J., Zimmerman B., Schaub F. (2018). Alexa, are you listening? Privacy perceptions, concerns and privacy-seeking behaviors with smart speakers. Proceedings of the ACM on Human–Computer Interaction, 2(CSCW), 1–31
10.1145/3274371 Crossref, Google Scholar - Liu L., Stroulia E., Nikolaidis I., Miguel-Cruz A., Rios Rincon A. (2016). Smart homes and home health monitoring technologies for older adults: A systematic review. International Journal of Medical Informatics, 91, 44–59
10.1016/j.ijmedinf.2016.04.007 PMID:27185508 Crossref Medline, Google Scholar - Lorig K. R., Holman H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26(1), 1–7
10.1207/S15324796ABM2601_01 PMID:12867348 Crossref Medline, Google Scholar - Machado G. C., Pinheiro M. B., Lee H., Ahmed O. H., Hendrick P., Williams C., Kamper S. J. (2016). Smartphone apps for the self-management of low back pain: A systematic review. Best Practice & Research. Clinical Rheumatology, 30(6), 1098–1109
10.1016/j.berh.2017.04.002 PMID:29103552 Crossref Medline, Google Scholar - Malec M., Shega J. W. (2015). Pain management in the elderly. The Medical Clinics of North America, 99(2), 337–350
10.1016/j.mcna.2014.11.007 PMID:25700587 Crossref Medline, Google Scholar - Mendoza T., Mayne T., Rublee D., Cleeland C. (2006). Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. European Journal of Pain (London, England), 10(4), 353–361
10.1016/j.ejpain.2005.06.002 PMID:16051509 Crossref Medline, Google Scholar - Moar J. (2017).Amazon Echo and Google Home to reside in over 50% of households by 2020, as multi-assistant devices take off. https://www.juniperresearch.com/press/press-releases/amazon-echo-google-home-to-reside Google Scholar
- Nielsen J., Landauer T. K. (1993). A mathematical model of the finding of usability problems. CHI '93: Proceedings of the INTERACT '93 and CHI '93 Conference on Human Factors in Computing Systems, 206–213.
10.1145/169059.169166 Crossref, Google Scholar - O'Brien K., Liggett A., Ramirez-Zohfeld V., Sunkara P., Lindquist L. A. (2020). Voice-controlled intelligent personal assistants to support aging in place. Journal of the American Geriatrics Society, 68(1), 176–179
10.1111/jgs.16217 Crossref Medline, Google Scholar - Palanica A., Thommandram A., Lee A., Li M., Fossat Y. (2019). Do you understand the words that are comin outta my mouth? Voice assistant comprehension of medication names. npj Digital Medicine, 2(1), 55
10.1038/s41746-019-0133-x Crossref Medline, Google Scholar - Parker S. J., Jessel S., Richardson J. E., Reid M. C. (2013). Older adults are mobile too! Identifying the barriers and facilitators to older adults' use of mHealth for pain management. BMC Geriatrics, 13(1), 43
10.1186/1471-2318-13-43 PMID:23647949 Crossref Medline, Google Scholar - Poleshuck E. L., Green C. R. (2008). Socioeconomic disadvantage and pain. Pain, 136(3), 235–238
10.1016/j.pain.2008.04.003 PMID:18440703 Crossref Medline, Google Scholar - Pradhan A., Mehta K., Findlater L. (2018). “Accessibility came by accident”: Use of voice-controlled intelligent personal assistants by people with disabilities. CHI '18: Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems, (459), 1–13.
10.1145/3173574.3174033 Crossref, Google Scholar - Reid M. C., Eccleston C., Pillemer K. (2015). Management of chronic pain in older adults. BMJ (Clinical Research Ed.), 350, h532
10.1136/bmj.h532 PMID:25680884 Crossref Medline, Google Scholar - Reid M. C., Papaleontiou M., Ong A., Breckman R., Wethington E., Pillemer K. (2008). Self-management strategies to reduce pain and improve function among older adults in community settings: A review of the evidence. Pain Medicine, 9(4), 409–424
10.1111/j.1526-4637.2008.00428.x PMID:18346056 Crossref Medline, Google Scholar - Roberts A. W., Ogunwole S. U., Blakeslee L., Rabe M. A. (2016). The population 65 years and older in the United States: 2016. https://www.census.gov/content/dam/Census/library/publications/2018/acs/ACS-38.pdf Google Scholar
- Shade M. Y., Berger A. M., Chaperon C., Haynatzki G., Sobeski L., Yates B. (2017). Factors associated with potentially inappropriate medication use in rural community-dwelling older adults. Journal of Gerontological Nursing, 43(9), 21–30
10.3928/00989134-20170406-01 PMID:28399319 Link, Google Scholar - Shade M., Boron J., Manley N., Kupzyk K., Pullen C. (2019). Ease of use and usefulness of medication reminder apps among rural aging adults. Journal of Community Health Nursing, 36(3), 105–114
10.1080/07370016.2019.1630960 PMID:31291770 Crossref Medline, Google Scholar - Shade M. Y., Herr K., Kupzyk K. (2019). Self-reported pain interference and analgesic characteristics in rural older adults. Pain Management Nursing, 20(3), 232–238
10.1016/j.pmn.2019.03.001 PMID:31080145 Crossref Medline, Google Scholar - Stubbs B., Schofield P., Patchay S. (2016). Mobility limitations and fall-related factors contribute to the reduced health-related quality of life in older adults with chronic musculoskeletal pain. Pain Practice, 16(1), 80–89
10.1111/papr.12264 PMID:25469983 Crossref Medline, Google Scholar - Vacher M., Lecouteux B., Istrate D., Joubert T., Portet F., Sehili M., Chahuara P. (2013). Experimental evaluation of speech recognition technologies for voice-based home automation control in a smart home. 4th Workshop on Speech and Language Processing for Assistive Technologies, 99–105. http://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=3ABEF0E41E4E5A7AF98CCB0C3B0465B4?doi=10.1.1.377.7017&rep=rep1&type=pdf Google Scholar
- Vaportzis E., Clausen M. G., Gow A. J. (2017). Older adults perceptions of technology and barriers to interacting with tablet computers: A focus group study. Frontiers in Psychology, 8, 1687
10.3389/fpsyg.2017.01687 PMID:29071004 Crossref Medline, Google Scholar - Virzi R. A. (1992). Refining the test phase of usability evaluation: How many subjects is enough?Human Factors, 34(4), 457–468
10.1177/001872089203400407 Crossref, Google Scholar - Wallace T., Morris J. T. (2018). Smart speaker usability by military service members with mTBI and PTSD. The Journal on Technology and Persons with Disabilities, 127–139. http://scholarworks.csun.edu/bitstream/handle/10211.3/202991/JTPD-2018-ID16-p127-139.pdf?sequence=1 Google Scholar
- Wolters M. K., Kelly F., Kilgour J. (2016). Designing a spoken dialogue interface to an intelligent cognitive assistant for people with dementia. Health Informatics Journal, 22(4), 854–866
10.1177/1460458215593329 PMID:26276794 Crossref Medline, Google Scholar - Zeng E., Mare S., Roesner F. (2017). End user security and privacy concerns with smart homes. Proceedings of the Thirteenth Symposium on Usable Privacy and Security (SOUPS 2017), 65–80. https://www.usenix.org/system/files/conference/soups2017/soups2017-zeng.pdf Google Scholar
