Yet medical device companies design products that depend on instructions and training to achieve proper use and adherence. Even worse, some of these devices are designed with the expectation that they can mitigate poor design thorough instructions or training.
Poor design leads to usability and adherence problems because basic human factors and an understanding of the actual context of use were not taken into account appropriately in the design process. It is not reasonable to expect that training and instructions can overcome poor design. Furthermore, many users—especially users of personal medical devices like inhalers, injections pens or blood glucose meters—do not read instructions and do not receive any training at all.
Routine experiences in doctor’s offices, particularly in primary care, compound the issue. Staff in a busy doctor’s office will write prescriptions, but frequently do not have the time or personnel to provide adequate training on a newly prescribed device. Pharmacists try to fill the gap here, but once a patient gets the device home and tries to use it for the first time, confusion or forgetting ensues, resulting in improper use or maybe no use at all. Even patients who receive adequate training and try to follow the instructions can be challenged to properly adhere.
Consider the need to prime a device like an insulin pen when it needs a new needle or a multi-dose disposable inhaler before first use. There are not many things in a consumer’s everyday life that they require priming before use so creating a mental model of why they need to do this is difficult. In addition, this is an infrequent step in the process—it only happens occasionally (unless you change your insulin pen needle every time, which many people do not), making this step easy to forget.
Further, there may be a perception among patients that they are “wasting” medication, and thus money, in the priming step. Despite assurances that there is extra medication in the device to account for priming, which may mitigate the cost issues somewhat, this does not address the waste issue. In addition, a user does not see an obvious difference if they forget the priming step even though they are getting an inaccurate dose.
We ask patients to integrate medical devices into their daily lives. This is more likely to successfully happen if we understand them as consumers, not patients. Their lives are filled with intuitive consumer products that do not require extensive training or detailed instructions to use correctly. We need to hold simple personal medical devices to the same standard.