Academic journal article Human Factors

Medication Schemas and Memory for Automated Telephone Messages

Academic journal article Human Factors

Medication Schemas and Memory for Automated Telephone Messages

Article excerpt

The present study investigated whether older and younger adults use a schema to organize and remember spoken reminder messages for taking medication. Previous research has shown that older and younger adults share preferences for organizing printed instructions for taking medication, suggesting a shared schema. Older and younger participants in Experiment 1 of the present study used a similar schema to organize medication reminder messages. This finding suggests that the medication schema generalizes across communication purpose (to remind or to instruct) as well as across patient age. Medication reminder messages were better understood and remembered when organized to match this schema, whether the reminders were presented as automated telephone messages (Experiment 2) or in printed form (Experiment 3). Schema-compatible organization especially helped people draw inferences from the messages, suggesting that organization helps older and younger adults construct a situation model of the medication-taking task from the messages. Potential applications of organized messages include increasing the impact of automated systems for delivering health services.

INTRODUCTION

Aging and Automated Health Communication

Health communication has become increasingly automated. For example, computer-generated instructions for prescribed medications are now provided at most pharmacies (Food and Drug Administration, 1995). Telephone communication between health providers and patients has also become automated. Computerized messaging systems are used by many health organizations to telephone patients, reminding them to keep appointments or take medication, or to provide other services (e.g., Leirer, Tanke, & Morrow, 1993). Automated communication has dramatically increased the amount of health information provided to patients. However, expanded information will improve health care only if it is easy for patients to understand and remember when performing routine health care tasks, such as taking medication or attending appointments.

Expanded health communication poses special challenges for older adults. Because they require more health services than do younger adults (e.g., U.S. Department of Health and Human Services, 1990), they are more likely to receive health communication. At the same time, age-related declines in working memory capacity or processing speed may impair their ability to understand information (Salthouse, 1991). Age differences in working memory measures predict differences in recall of printed (e.g., Hartley, 1993) and spoken text (e.g., Stine & Wingfield, 1990). Older adults often have trouble understanding health information because of such age-related changes in cognitive abilities and because of limited literacy. For example, a recent survey found that 33% to 44% of community-dwelling Medicare enrollees (in several samples) did not understand basic information related to taking medication, operating medical devices, and keeping appointments (Gazmararian et al., 1999). Thus health care messages must be designed with the needs and abilities of older adults in mind in order to help them understand and remember how to perform health activities.

Although automated messages have been shown to improve appointment attendance (e.g., Leirer, Morrow, Pariante, & Doksum, 1989; Tanke, Martinez, & Leirer, 1997) and medication adherence (e.g., Tanke & Leirer, 1994), these studies have not attempted to optimize the messages themselves. Improving the design of automated messages should in turn increase the potential impact of automated systems for delivering health services.

Comprehension and Message Organization

Understanding text generally requires several levels of representation. Listeners represent the situation or events described by the text (the situation model or mental model) as well as the text itself (van Dijk & Kintsch, 1983; Zwaan & Radvansky, 1998). …

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