As manufacturers look to provide treatments for the long-term management of increasingly complex diseases and medical conditions, Cambridge Consultants discusses the role of design in meeting the needs of an ageing population and the trend towards self-medication by patients at home
Design has always played a pivotal role in meeting the needs of the users of medical devices
Many Western countries are heading for a crisis, but it is one that great industrial design can help us to overcome. Over the past few decades, life expectancy has increased and so the percentage of elderly people in the general population has grown steadily. By 2037, the number of people over 85 years old in the UK is projected to be two and a half times what it is today. People aged over 65 will account for 24% of the population.
The impact of this shift will affect many aspects of our lives, but one key area is how our healthcare industry provides for the inevitable increase in demand. With hospital facilities already stretched to breaking point, helping people to look after themselves for longer in their own homes is going to be important.
Devices and device packaging will need to be designed to be safe and effective for a population with very wide-ranging capabilities
This means that non-healthcare professionals will be increasingly needed to administer drug delivery regimes and to closely monitor their outcomes. As a result, devices and device packaging will need to be designed to be safe and effective for a population with very wide-ranging capabilities.
Design has always played a pivotal role in meeting the needs of the users of medical devices. Good design guides the user’s interaction, reassures them through the process and feeds back evidence of the successful outcome. With an ageing population this is especially important. This is true of devices designed for medical professionals, but is more important for untrained patients.
The growing trend for self-medication, in the home, creates unique challenges for designers. How should design deal with the wide variation in patient capability and understanding, the different environments and lifestyles and the variety of preconceptions patients bring to their understanding of a medical device? Understanding these parameters is a vital input into the design process.
With modern ethnographic research, a deeper understanding can be obtained of how devices are used and sometimes misused. Ethnographic techniques mean going into homes and watching how people react, not simply asking them what they do. Only by understanding how patients really interact with their devices can they be designed to be more effective.
Only by understanding how patients really interact with their devices can they be designed to be more effective
Most packaging design for pharmaceutical products is tailored for impact on the shelf, for readability in a dispensing pharmacy and for brand recognition; how this packaging fits into the domestic setting is a lower order consideration but this has to change. Many pharmaceuticals live in the domestic refrigerator, jostling for space with food and drink products. Clearly there is a need to differentiate and ensure they are safely stored but there is also the need to consider the lifestyle of the family unit. This is not just about discreet packaging, it is also about the messages projected by that packaging.
Over their lifetime, most elderly patients have acquired a huge amount of experience and bring this knowledge, sometimes at a subconscious level, to every new experience. When presented with an injection device for home use a new patient has already formed a view on how the experience will be before they have even opened the packaging. Design has a huge role to play in easing this experience, providing friendly, encouraging cues and ensuring that first impressions are positive ones.
The external packaging and instructions for use are the first touch point for the new user and our expectations of quality are set by the consumer product we interact with every day. A patient starting a new therapy probably already has a negative preconception (maybe they have just been diagnosed with a new condition); in this frame of mind intimidating them with an overly ‘medical’ experience places a barrier between them and the delivery system. It should not be forgotten that these people may feel intimidated by a new mobile phone or television setup – the very things intended to benefit them.
At the other end of the age spectrum some pharma products are handled by children (Cystic Fibrosis or Type 1 diabetics, for example), often being stored in their bedrooms, where they play with friends. While it is not being suggested such medical products should look like toys, they do need to live in this environment and gain acceptance as a beneficial part of the child's world rather than an intrusive incursion from the adult world.
Design can be made to look more familiar, perhaps following styling cues from objects that are easily understood
Design can therefore be made to look more familiar, perhaps following styling cues from objects that are easily understood. Borrowing familiar design languages is an effective ploy used by designers as a visual ‘short-cut’. If a device looks like a ball pen, people automatically know how to pick it up and hold it, the cap obviously comes off and the business end is underneath. Often subtle features can jog a subconscious memory of how a thing might twist or pull or push, but only if the experiences match the usage.
Someone who is 65 today is of a different generation from an 85-year-old with very different life experiences, yet it is easy to group them in the same category. This is a constantly evolving picture; a 65-year old today may not be familiar with the controls of a gaming console, but this might be very different in this age group in 20 years’ time.
Medical devices are increasingly following a more consumer aesthetic as a way to break down the barriers of understanding and compliance. People don’t stop being consumers when they are sick or old, and making medical devices fit aspirational lifestyles can help integrate them into their lives. Objects that have a high perceived quality are better looked after and less likely to be put in a drawer and forgotten. Design should also reassure users that their device is safe and easy to use.
In the consumer world, people place incredible trust in leading brands. They will buy new Apple products on the day they are released, before any reviews come out. Some leading car brands can sell purely on the strength of their ‘keyring’ (the brand), without the buyer taking the car for a test drive. The brand has become a promise to the buyer that the product will perform as expected.
Even small companies with a single product can establish brand equity in a matter of seconds that will last a lifetime
In consumer products, branding is well understood, but many medical companies underplay the strength of brand loyalty. Even small companies with a single product can have a strong brand and can establish brand equity in a matter of seconds that will last a lifetime. As patient choice becomes ever stronger this will become more important; a brand is a promise and in healthcare, more than in other businesses, promises are important.
The unboxing video has become a new rite of passage for leading packaging designers, a harsh, immediate review of their designs. On YouTube there are excited consumers who expect the theatre of unboxing a new device to be every bit as good as the device itself. The top consumer electronics companies are in an arms race to make this experience – possibly our first physical interaction with their brand – a memorable one (how many millions of iPhone owners keep the packaging, despite the fact that they will never put their phones back into it?). Perhaps there is a lesson to be learned by pharmaceutical and medical device companies that what they are currently doing is not good enough.
In the US we increasingly see the celebrity endorsement culture building brands in the medical sector and this too can have a positive impact on product compliance. When David Beckham was seen using an inhaler it helped to de-stigmatise asthma among children.
Wearable devices could start actually to become cool in our increasingly fashion-conscious world
As the elderly make greater use of wearable devices they could start actually to become cool in our increasingly fashion-conscious world. Hearing aids are now styled to look like high end earbuds and some prosthetic limbs are sculptural works of art that look more like sports accessories than medical interventions.
As new technologies develop, there is going to be an explosion of wearable pumps and monitors, diagnostic tools and performance altering controls – do people really need to hide them away?
Reliance on instructions is always a poor substitute for an intuitive, or better still, fool-proof method of operation. As devices become more capable, they often become more complicated and this trend is likely to continue as medical devices become increasingly electronically enabled. Maintaining a simple and effective interface in the world of fast-paced technological progress is going to be one of the biggest challenges for designers over the next few years. The current bandwagon is to make every interface into a touch screen, but is this the best approach for the elderly? The main advantage of a touch screen is that it presents choices appropriate to the context. They should be simple to use, but touch screens rely on the user being comfortable with layers of choices and information.
Often for the elderly the fear of making a mistake can be crippling
Often for the elderly the fear of making a mistake can be crippling; not knowing the implications of a choice in advance leads to inaction (what is going to happen when I press this button? What will I do if the screen goes blank?). Why not present a simple analogue interface where choices can be easily made and reversed in a threat-free way? A user-centric rather than a technology-centric approach to presenting new systems has to be the most effective way forward.
Connectivity is another buzzword that is creeping into all areas of the healthcare market. As we become increasingly connected, the expectation is that soon everything in our lives will be smart and enabled. For the patient this has the obvious advantages that home medications and outcomes can be monitored and influenced remotely. The capabilities have been with us for some time but the infrastructure has yet to catch up. In a world with so much real time information available how are we going to keep on top of it? Increasingly we will be reliant on cloud-based algorithms to run our lives rather than the beleaguered healthcare professionals.
Once again the challenge will be designing appropriate interfaces to ever more powerful systems. Here a step change will be needed; the elderly cannot be expected to keep up with ever more complex computer interfaces, simplicity has to be reasserted. For an ageing population physical and cognitive impairment combine with a fear of new technologies to provide a perfect storm raging against adopting new technology. The skill of the designer will be to make this technology not just accessible but also trustworthy.
For pharmaceutical companies and healthcare providers personalised medication is a key direction for the future. With the increasing cost of critical medications tailoring medication to the individual has clear benefits, but by closing the feedback loop we can ensure that their outcomes are optimised on a daily, or even minute-by-minute basis. Once again the trend will be for patients to take a higher level of responsibility for their medication.
Many long-term sick become real experts in their treatment (they live with it day to day after all) and they often develop rituals to ensure they follow their medication regime effectively. Design also has a key role to play here.
The ritual for using a medication can be a big part in sustaining compliance
The ritual for using a medication can be a big part in sustaining compliance. This could be as simple as laying out the components on a prepared mat, or making a cup of tea while gathering the courage to administer an injection. Understanding these rituals and the drivers behind them helps us design to accommodate them; we should be helping people after all.
The use of a medical device can become a little piece of ‘theatre’ if designed appropriately. Adding a little joy to the way two parts are snapped together might seem unlikely in a drug delivery device, but we see it every day in our consumer electronics, in the way a door latches or a pen lid clicks into place. We should not underestimate the value of little pleasures.
In the final reckoning, designers need to ensure that medical devices are safe and effective to use and for the elderly and infirm this can be a significant challenge. They should be designed to be intuitive to use, easy to understand and difficult to get wrong.
Ideally, a new medical device should be designed so it cannot be used incorrectly, but more critically it should also reassure the patient that this is so. If the patient is too scared to use it there is no benefit in it being easy to use.
Ultimately our aspiration can go even further: why can’t the next generation of medical devices actually be a joy to use?
The Bydureon Pen is a pre-filled, single-use pen injector that eliminates the need for the patient to transfer the medication between a vial and syringe during the self-injection process. The exenatide microspheres and diluent are housed in separate chambers within the pen device and only mixed at the time of injection.
Cambridge Consultants used its industrial design and human factors expertise in developing the usability of the Bydureon Pen. The design guides the patient to the right place to grip the pen – and leads them naturally to hold the device at the correct angle that enables the drug to be mixed properly before injection. The design includes ‘windows’ which show the mixing process inside the pen injector – to focus the user’s attention on this key element of the process.
‘Our objective was to make the whole procedure as simple as possible, eliminating the need for the patient to transfer the medication between a vial and syringe during the self-injection process,’ said Andy Pidgeon, head of the industrial design and human factors group at Cambridge Consultants. ‘We carried out extensive usability testing to ensure both patients and healthcare professionals were able to use the Bydureon Pen successfully.’