Abstract
Keywords
Between 2015 and 2016, nearly half of Americans used a prescription drug within a month's timeframe (Martin et al., 2019). Extensive use of prescriptions has directed greater attention toward the causes of prescription-related errors. According to the United States Food and Drug Administration (2019), the organization receives over 100,000 suspected medication errors annually. Medication errors are costly and occur across settings as well as levels of care (da Silva & Krishnamurthy, 2016).
The potential for medication errors prompts additional concerns for those experiencing vision loss. According to the 2018 National Health Interview Survey, approximately 32.2 million adults aged 18 and older reported experiencing difficulty with vision, despite wearing glasses or contact lenses, including those individuals who reported blindness (Blewett et al., 2019). Differences in models of service delivery and nomenclature pose further challenges among health care professionals when addressing vision loss (Massof & Lidoff, 2001).
In addition to a lack of consensus, operational definitions of low vision may not thoroughly reflect the scope of functional impact on daily function (Massof & Lidoff, 2001). The National Eye Institute (NEI) describes low vision based on a visual acuity of less than 6/12 or 20/40 that is non-correctable (NEI, 2019b) and expects this population to rise to 8.3 million by 2050 (NEI, 2019a). Massof and Lidoff (2001) advocated for a comprehensive definition, beyond visual acuity, to include factors, such as contrast sensitivity, glare, and visual field loss. Applying this inclusive perspective reflects the complex visual system and the comprehensive approach needed to address factors beyond visual acuity.
Low vision or blindness may increase the risk of errors due to difficulties with reading medication labels. McCann et al. (2012) discovered 97.4% (n = 152) of participants with low vision self-reported having difficulty reading medication labels. Opening medications and distinguishing medications were also found to be self-reported challenges in managing medications (McCann et al., 2012). Errors may occur due to difficulties in distinguishing print size, font, contrast, and contour (Taylor et al., 2016).
Individuals with low vision or blindness may need to use strategies or assistive devices to safely manage prescriptions. Assistive devices may include closed-circuit televisions (CCTVs), portable electronic magnifiers, and non-electronic magnifiers (American Foundation for the Blind, 2020). Audible assistive devices are also commercially available for medication management but not widely used (McCann et al., 2012; McMahon & Curtis, 2009).
Literature Review
Assistive Devices and Legislation Accessible Label Solutions
The Food and Drug Administration Safety and Innovation Act of 2012 prompted national attention about medication safety (P.L. 112–144). Section 904 of this federal law established a work group to identify best practices to support accessible prescription labels. The work group, which comprised of representatives from the pharmaceutical industry and national advocacy organizations, disseminated the guidelines in partnership with the National Council on Disability (United States Access Board, 2013). The guidelines included the use of dedicated voice or text-to-speech devices, radio-frequency identification (RFID) technology, and smart devices or computers, whereby an electronic system encodes prescription information, making labels accessible through other technology (United States Access Board, 2013).
Recent legislation was enacted to improve accessibility for medications for those living with low vision and blindness. The State of Nevada (2017) updated its statutes for pharmacists and pharmacies by defining prescription readers as “a device designed to convey audibly the information contained on the label or other device affixed to the container of a prescription drug to a person who is visually impaired or otherwise would have difficulty reading the label” (p. 484). This landmark legislation also required retail and community-based pharmacies to provide prescription readers upon request, for at least the duration of the prescription, and to include appropriate education to consumers with visual or print disabilities (State of Nevada, 2017). The State of Oregon also enacted legislation requiring pharmacies to notify and provide consumers with audible prescription labels (State of Oregon, 2019).
Other states are exploring accessible label practices and services to support consumer safety. Tasked by the state's legislature, Maine's Board of Pharmacy urged pharmacists and pharmacies to integrate best practices for supporting consumers who experience challenges to view and read essential information from prescription labels (Maine Department of Professional & Financial Regulation, 2021). Ohio, Massachusetts, Pennsylvania, and Minnesota also introduced legislation to cultivate medication safety among this population (Commonwealth of Massachusetts, 2019; General Assembly of Pennsylvania, 2018; Minnesota Legislature, 2020a, 2020b; Ohio Legislature, 2019; State of Oregon, 2019). These initiatives reflect greater attention toward safety and accessible label practices and may expand with an increased incidence of low vision and blindness.
Strategies for Medication Management
Prior research examined how individuals with low vision and blindness managed prescriptions. According to McCann et al. (2012), 80.1% (n = 125) of participants with visual impairments used optical aids, making it the most commonly used strategy for medication management. However, 97.4% (n = 152) of the participants with visual impairments reported difficulty with reading medication labels. Participants also reported using a medication organizer, relying on a relative or friend, and utilizing a pharmacy service for pre-packaging and organizing medications. Because categories were not mutually exclusive, participants could use multiple strategies. These data suggest optical aides do not provide a sole, comprehensive solution for every end user. Additional research is necessary to examine the effectiveness and viability of other assistive devices, including audible prescription readers.
McMahon and Curtis (2009) found individuals most often relied on magnification devices or other individuals to read medication labels. Only one among the 283 participants used an audible reading device (McMahon & Curtis, 2009). McMahon and Curtis (2009) advocated for additional research on these devices since they were not readily used. This literature gap indicated support for this study, which focused on the ScripTalk® device.
Audible Prescription Reader
The ScripTalk® device utilizes text-to-speech technology to assist individuals with reading impairments, low vision, or blindness. This device and a smartphone application are commercially available from En-Vision America, and both stand-alone products read labels (En-Vision America, 2020b). Through RFID technology, the device identifies information from labels programmed by pharmacies (En-Vision America, 2020a). Using specialty software, pharmacy professionals print RFID labels with information, such as the prescription name, dosage, physician's information, instructions, and warnings (En-Vision America, 2020a). The bottom adhesive RFID labels are secured to the bottles while the standard labels are placed circumferentially. When the bottle is placed over the unit, the ScripTalk® device scans and reads a label's content aloud. The device does not save recordings, and end users may rescan multiple labels. While this technology offers a practical solution, a gap exists in the literature about this device.
This descriptive study aimed to evaluate accuracy and device satisfaction of the ScripTalk® device among adults with low vision and blindness. The researchers identified key definitions for the purpose of this study. Accuracy was defined as the number of correct responses to 12 questions about label content on three empty prescription bottles. The researchers defined user satisfaction based on the constructs and scores provided by the Device Subscale of the Quebec User Evaluation of Satisfaction with Assistive Technology, Version 2.0 (QUEST 2.0). Wittich et al. (2018) utilized this assessment to compare satisfaction and speed as subjects with low vision read various labels with two different magnification devices.
Methods
Researchers obtained approval from the university's Institutional Review Board. The researchers collected data between July and September 2020. Data collection occurred at community-based sites for low vision support groups located in the Midwest as well as three homes of affiliated participants.
Participants
The researchers recruited participants through snowball and convenience sampling, primarily through the low vision support groups. The researchers did not distinguish visual acuity in the inclusion criteria. Rather, the researchers sought to incorporate a comprehensive scope to permit participation among individuals who may be experiencing various visual conditions. According to inclusion criteria, participants were 18 years or older adults, English-speaking, self-reported having at least one diagnosis leading to low vision or blindness, and took at least one prescribed medication. All participants demonstrated functional hearing abilities, which was evidenced by their ability to respond to the demographic questions read aloud by the researchers and by participants’ abilities to adjust the volume to their preference while trialing the device.
Instrumentation
Equipment
Four RFID labels were programmed with information. One bottle contained a simple sentence to screen functional hearing. The remaining three bottles contained information representing different prescription names, dosages, instructions, warnings, and physicians’ names. Based on common prescriptions identified by Martin et al. (2019), the researchers selected Sectral®, CRESTOR®, and Sertraline to represent the three prescription names used in the present study. Simulated information represented different dosages, instructions, and names of prescribing physicians. The RFID labels were secured to the bottom of four 13-dram sized, empty prescription bottles. Prior to data collection, the researchers confirmed the ScripTalk® device successfully scanned and read each RFID label. The bottles’ printed labels were covered with an opaque, thermoplastic material to preclude use of any residual vision.
All participants practiced with one trial bottle to ensure they could successfully hear the auditory output, operate the device, and adjust volume after receiving training from the researchers. Three additional bottles, designated as Bottle 1, Bottle 2, and Bottle 3 for identification purposes, were used for data collection. The researchers requested mock prescription information from the participants in a randomized order, using a randomizing software (i.e., Research Randomizer).
The ScripTalk® device offers a simple design. Though the device includes an AC adapter, using AA batteries permitted portability for this study. The manufacturer's instructions also indicate how the device can mount to a wall. The thumbwheel, located in front of the unit, permitted participants to adjust the volume and turn the unit on and off. The shape, orientation, and location of the unit's three buttons on top of the device allowed participants to differentiate the buttons and their corresponding functions. Pushing the circular “Read” button, equipped with a tactile dot, activates the device to scan and read RFID labels. Participants advanced through and repeated prescription information by pushing the two triangular buttons, representing the “Next” and “Prev” (i.e., Previous) features, as necessary. The device's surface includes raised dots as tactile cues in the center of the device to direct placement of the bottles over the unit.
Participants’ verbal responses for qualitative data were audio recorded with the EBoTrade 8GB Multifunctional Digital Voice Controller. Audio recordings permitted transcription of qualitative data and verification of quantitative data.
Accuracy Assessment
To assess accuracy, the researchers asked four randomized questions about a label's content after each participant scanned a bottle and listened to the device's auditory output. Three bottles were used for data collection, which provided data for 12 questions. The researchers recorded each participant's responses on a chart and calculated an accuracy percentage based on identifying the prescription name, dosage, instructions, and prescribing physician for all bottles.
QUEST 2.0 Device Subscale
The researchers selected the QUEST 2.0 to evaluate constructs related with user satisfaction toward assistive devices. The QUEST 2.0 is comprised of an eight-item Device Subscale and a four-item Services Subscale (Demers et al., 2002). The researchers only administered the Device Subscale to participants. The Device Subscale offers sufficient reliability based on the intraclass correlation coefficient of 0.82 (Demers et al., 2002).
The Device Subscale utilizes a 5-point Likert scale and permits respondents to rate their self-perceived satisfaction based on a device's Weight, Comfort, Ease in Adjusting, Safety & Security, Durability, Ease of Use, Comfort, & Effectiveness (Demers et al., 2002). The scale ranges from one to five, corresponding to “Not Satisfied at All” to “Very Satisfied,” respectively (Demers et al., 2002). Because “four” represents “Quite Satisfied,” the researchers defined “Satisfaction” for this study based on the frequencies for items that participants rated with “fours” and “fives.” The QUEST 2.0 provides an opportunity for participants to describe reasons for rating a construct as four or less on the Likert scale (Demers et al., 2002).
Qualitative Interview
The researchers gathered additional qualitative data of participants’ perspectives after using the device. Six open-ended interview questions were constructed through triangulation:
How comfortable did you feel using ScripTalk®? What features made the device easy to use? What were the challenges you faced while using the device? Describe your level of confidence while using ScripTalk® in regards to the device's accuracy. How likely are you to use ScripTalk® device in the future? a. Why or why not? Do you perceive that you would use the ScripTalk® device in three months? Six months? Twelve months?
6. How do you feel the ScripTalk® could assist with managing your medication safely?
Procedures
The researchers developed a concise script, based on the manufacturer's printed instructions, to provide training on the device and its features. The researchers read the script to train those who piloted the methodology prior to data collection. Three individuals, possessing no previous experience with the ScripTalk® device, piloted the procedures, equipment, and assessments while wearing blindfolds to occlude their vision.
Participants were assigned de-identifying codes for all printed documents and electronic data to ensure confidentiality. The researchers read the informed consent forms aloud to all participants to account for vision loss. Upon obtaining their written consent, the researchers read the demographic survey and recorded participants’ responses. For the survey, eye conditions and management methods were not mutually exclusive categories. Participants could respond to multiple response options for each of these demographic items. Following the survey, participants were trained on the device with the script. Each participant demonstrated how to accurately turn the device on and off, adjust the volume, and activate the scanning feature to read the RFID labels. The researchers permitted participants to repeat and advance through auditory information from the labels as needed, since these features are readily available to end users.
Following practice with the trial bottle, participants scanned each RFID label for the three bottles used, listened to the auditory output, and verbally responded to four randomized questions related to the label's content (i.e., Prescription Name, Dosage, Instructions, and Physician's Name). The researchers read the QUEST 2.0's Device Subscale and transcribed participants’ responses on the subscale's form. Qualitative interviews were conducted with each participant and concluded data collection. All verbal responses were audio recorded to permit transcription. Printed documents were stored in a locked file cabinet in the principal researcher's office. The researchers had sole access to the file cabinet and to the electronic data secured on a password-protected computer.
Data Analysis
The researchers utilized SPSS (Version 27.0) to code and analyze de-identified data from the demographic survey, accuracy assessment, and the QUEST 2.0's Device Subscale. Descriptive statistics were tabulated for demographic data. Frequency distributions were calculated for each of item of QUEST 2.0's Device Subscale. Pairs of researchers transcribed interview responses with Microsoft WordTM and verified Device Subscale comments from the voice recorders to ensure accuracy. Through thematic analysis and triangulation with peer checking, key themes were identified from the qualitative data. A Spearman correlation was calculated to identify the relationship between accuracy and each of the satisfaction constructs in the QUEST 2.0's Device Subscale. Statistical significance was set at an alpha level of p < .05.
Results
Quantitative Results
Twenty-three participants (N = 23) partook in the study. Participants’ ages ranged from 44 to 94 years old (M = 65.04, SD = 14.38). Females (n = 17) represented 70% of participants, and males comprised 30.4% (n = 6). The majority (n = 20) of participants (87%) identified their ethnicity as Caucasian or White, while African American or Black ethnicity (n = 3) represented 13%. The years of living with low vision or blindness ranged from 2 to 68 years (M = 27.83 years, SD = 21.21). Approximately 30% (n = 7) had lived with low vision or blindness for nine years or less, followed by 21.7% (n = 5) who lived with low vision or blindness between 50 and 59 years. Nineteen participants (82.6%) reported having only one medical condition or diagnosis resulting in either low vision or blindness. Only 8.7% (n = 2) participants reported having two or three conditions resulting in low vision or blindness. Macular degeneration was reported by 43.5% (n = 10) participants, and Retinitis Pigmentosa and untreatable cataracts were each represented among 13% (n = 3) of participants.
Over one-third (n = 8) of participants, incorporated environmental placement as a management strategy for their current prescriptions. Optical devices, including CCTV's, non-electronic magnifiers, and portable electronic magnifiers, were utilized by 30.4% (n = 7). Three participants (13.0%) possessed experience with using the ScripTalk® device for their current prescriptions. The smartphone application titled ScripTalk Mobile® was used by 8.7% (n = 2) of participants to identify prescription information. Table 1 contains additional demographic data.
Demographic Data.
Note. Percentages are based on the total participants (N = 23). Eye conditions and management methods were not mutually exclusive categories. Participants could respond to multiple response options for each of these demographic items.
Accuracy rates were calculated for the three bottles based on the number of correct responses to 12 cumulative questions. Table 2 lists the cumulative percentages of accuracy for Bottles 1, 2, and 3. The highest accuracy rate occurred when participants identified “Instructions.” The accuracy percentages for “Instructions” among Bottles 1 and 2 were 91.3% (n = 21). The accuracy rate for Bottle 3 was 95.7% (n = 22). In contrast, the accuracy rates for “Prescription Name” for Bottles 1 and 2 each were 21.7% (n = 5), respectively.
Cumulative Percentages of Accuracy per Bottle.
Note. Values are based on total participants (N = 23).
Figure 1 displays the frequencies of Device Subscale's items by which participants indicated satisfaction. The researchers defined Satisfaction if participants provided scores of four or five, corresponding to “Quite Satisfied” or “Very Satisfied, respectively. Twenty-three (100%) participants reported satisfaction for the device's Ease in Adjusting and Comfort. Regarding Ease of Use and Weight, 95.6% (n = 22) of participants indicated satisfaction. Twenty-one participants (91.3%) expressed satisfaction with the device's Safety and Security as well as Durability. Twenty participants (87.0%) were satisfied with Dimensions. Eighteen participants (78.2%) reported satisfaction with Effectiveness.
Percentages of Satisfaction for QUEST 2.0's Device Subscale.
Spearman rank-order correlation coefficient tests determined the nature of relationships existing between accuracy percentages (i.e., physician, dosage, medication name, and instructions) for each of the three bottles and the eight satisfaction constructs within the QUEST 2.0's Device Subscale. To ascertain if results changed with the removal of the experienced ScripTalk® users, the researchers performed three Spearman rank-order correlation coefficient tests. First, accuracy and satisfaction data were applied for the statistical test for all participants (N = 23), regardless as to whether they had experience using the ScripTalk® device or ScripTalk Mobile® smartphone app. A second analysis was conducted with only “novel” ScripTalk® users (n = 18), meaning those participants who lacked prior experience using the ScripTalk® device or ScripTalk Mobile® smartphone app. Additionally, a third analysis was applied by using participants’ data while excluding those who used the ScripTalk Mobile® smartphone app (n = 21).
Through analysis of all participants’ (N = 23) data, statistically significant and inverse relationships were identified for pairwise comparisons between Bottle 2's Instructions Accuracy with Safety & Security (rho = −0.834, p < .001), Durability (rho = −0.690, p < .001), and Effectiveness (rho = −0.536, p < .01). Positive relationships of statistical significance were identified between Bottle 2's Dosage Accuracy with Ease of Use (rho = 0.473, p < .02) as well as Comfort (rho = 0.423, p < .045).
An additional Spearman rank-order correlation coefficient test was conducted among novel users (e.g., those lacking experience with either the ScripTalk® device or the ScripTalk Mobile® smartphone app (n = 18)). This revealed statistically significant, inverse relationships for Bottle 2's Instructions Accuracy with Safety & Security (rho = −0.839, p < .001), Durability (rho = 0.695, p < .01), and Effectiveness (rho = −0.547, p < .02). Additionally, two positive relationships were statistically significant between Bottle 2's Dosage Accuracy and Ease of Use (rho = 0.491, p < .04) as well as Bottle 1's Medication Accuracy and Durability (rho = 0.540, p < .03).
Three inverse relationships were statistically significant when data of participants who used the ScripTalk Mobile® smartphone application (n = 21) were excluded from the analyses. Inverse relationships were identified between Bottle 2's Instructions Accuracy when paired with Safety & Security (rho = −0.836, p < .001), with Durability (rho = −0.688, p < .001), and with Effectiveness (rho = −0.540, p < .01). Positive relationships were statistically significant between Bottle 2's Dosage Accuracy when paired with Ease of Use (rho = 0.492, p < .023) and Comfort (rho = 0.439, p < .047). Positive relationships were also statistically significant between Bottle 2's Medication Accuracy when paired with Safety and Security (rho = 0.460, p < .04). A positive relationship was statistically significant between Bottle 1's Medication Accuracy when paired with Ease of Use (rho = 0.444, p < .04). Finally, a positive relationship was statistically significant between Bottle 1's Medication Accuracy when paired with Durability (rho = 0.546, p < .013).
Qualitative Results
Interview Questions
Thematic analysis of qualitative data revealed key themes. Participants perceived the ScripTalk® device to be easy to use and comfortable and described the device as “simple” and “not intimidating.” Participants indicated how the straightforward design was most appealing and supported ease of use. They expressed appreciation for the device's three large and distinguishable buttons, the thumbwheel's location, and the single button used to scan labels. A secondary theme was the ease for learning how to operate the device.
A third theme revealed challenges when identifying unfamiliar names of medications through the device's auditory output. Two participants recommended a spelling feature for identifying unfamiliar words. Four participants indicated how using their personal medications or having prior knowledge of prescription names would affect their ability to identify prescription names.
QUEST 2.0 Device Subscale
Dimensions. Participants indicated the device possessed an appropriate size and shape. One participant remarked how the ScripTalk® device felt “natural” to use based on the thumbwheel's location. Another participant noted how the tactile dots helped to indicate the dimensions.
Weight of Device. Portability emerged as a key theme. One participant described the weight as “very lightweight, easy to handle.”
Ease in Adjusting. One participant commented, “It's a very easy device to use” with regard to ease in adjusting.
Safety and Security. Based on observations from field notes, one participant demonstrated how the device's non-skid surface, located under the unit, offered stability. When the participant pushed the device against the table, the device remained in place. This participant concluded, “It doesn’t slide around, so it's not going to slide off your table.”
Durability. Two participants remarked how this device's durability was important for managing medications while traveling. One participant inquired about the durability of the buttons and thumbwheel. While participants reported satisfaction for durability, two participants expressed concerns about the plastic construction but did not provide further explanations.
Ease of Use. According to one participant, the device is easy to use because only one button activates the scan. Another participant suggested a recessed area would permit users to place a bottle on top of the device. This construct of the Device Subscale also reiterated the theme of challenges to understanding pronunciation for novel prescription names. Participants perceived prior knowledge of prescription names was important for ease of use and for understanding the device's pronunciation.
Comfort. The auditory quality also emerged as a theme within the Comfort construct. Participants expressed how prescription names were challenging to understand, based on the output's clarity, which decreased their perceived satisfaction for comfort. Two participants possessed experience with the ScripTalk Mobile® application on their smartphones. Based on their experience, they expressed greater comfort with using the ScripTalk Mobile® application as they perceived its auditory quality was easier to understand than the ScripTalk® device.
Effectiveness. The automated quality of the device's output influenced satisfaction for effectiveness. One participant suggested a spelling feature could be helpful for effectiveness. A secondary theme revealed the device offered features to effectively manage prescriptions. One participant responded the device would be more beneficial for an individual who lives alone, but it would not be personally effective for them because they received assistance from another individual. Another participant commented the ScripTalk® device would not be useful to them personally as they currently manage one prescription without a device and experience no difficulty.
Discussion
Accuracy rates were highest when participants identified instructions with the ScripTalk® device. Because they had current prescriptions, participants’ prior knowledge or experiences may have provided contextual information, such as warnings. Having participants who were previously accustomed with the device could have impacted their reported effectiveness, comfort, and accuracy when using it. In contrast, participants were least accurate when identifying prescription names. Because the researchers did not indicate the prescription names in advance, participants relied on the device's auditory output and their auditory processing skills. Without such knowledge, participants may have lacked contextual information to identify complex and unfamiliar prescription names. According to qualitative themes, having advance knowledge of prescription names may have impacted participants’ perceptions of effectiveness and understanding the device's pronunciations.
The inverse relationship reflected through the Spearman test indicates that individuals’ accuracy rate with identifying information on labels, while using the ScripTalk®, does not necessarily predict user satisfaction. User satisfaction, as defined by the QUEST 2.0's construct items, is multifactorial. Based on the QUEST 2.0, user satisfaction, as examined in this study with the ScripTalk® device, can be described as a transactional relationship between physical characteristics of the device (e.g., weight, dimensions, durability, adjustability, ease of use, comfort) as well as the functional characteristics, such as effectiveness as well as safety and security. Inverse, statistically significant relationships occurred between the accuracy percentages of Bottle 2's Instructions and Dosage when compared with participants’ Safety & Security, Durability, and Effectiveness.
Familiarity with the device and the smartphone app differed within the sample. To account for these differences, three analyses for the Spearman Rank-Order Correlation Coefficient tests were conducted to analyze data among participants with no prior experience, to exclude those with device experience, and to parcel out those experienced with the mobile smartphone app. The differences between the results are minimal with statistical relationships remaining the same. When participants had experience with the ScripTalk® device, there was a positive relationship between Comfort and Dosage accuracy for Bottle 2 as well as between Effectiveness and Instructions Accuracy for Bottle 2. Based on these findings, the more experienced a participant was with the device, the more likely they were to report a higher score with the device's comfort and with their perceived effectiveness. Furthermore, those participants coincidently achieved higher scores in accuracy likely due to understanding the device better than participants who lacked experience.
Based on the QUEST 2.0 Device Subscale, participants were satisfied with the ScripTalk® device's ease of use, adjustability, comfort, and weight. Though over 75% (n = 18) of participants reported satisfaction with the device's effectiveness, this construct was the lowest among the subscale's items. This finding can likely be explained a key theme in the qualitative data. The researchers found the automated quality of the device's output posed challenges when identifying unfamiliar prescription names with the device, thus impacting user effectiveness.
Analysis of qualitative data from the Device Subscale may provide an explanation for the lower frequency of satisfaction for the “Effectiveness” construct. Participants appeared to base their scores by comparing their current methods used to manage medications. It is also imperative to note that having prior knowledge of the prescription names selected for this study may have influenced accuracy and user satisfaction.
Notably, auditory quality emerged as a salient factor among participants. An automated or robotic-like quality of auditory output could negatively influence identification of novel medication names. Using familiar prescription names may affect accuracy and user satisfaction among individuals using the ScripTalk® device.
The researchers acknowledge cost and availability could influence consumers’ overall satisfaction and decisions to use an assistive device. However, cost and availability are not constructs of the QUEST 2.0. While ScripTalk® devices are available at no cost to consumers through participating pharmacies, switching to such pharmacies could be a deterrent to some individuals. Therefore, examining the impact of cost and availability were beyond the scope of this study.
Strengths
The methodology offered several strengths. External validity was supported as participants experienced low vision or blindness, possessed experience with prescriptions, and used assistive devices and strategies for medication management. Prior to the accuracy assessment, participants demonstrated how to use the device properly with the trial bottle, which reduced confounding variables. In addition, covering the printed labels ensured reliance on the device's auditory output and prohibited participants from using any residual vision.
Limitations
The researchers identified limitations to the study. Due to the ScripTalk® device's specific features, the findings offer no generalizability to other devices. Audible prescription readers may vary in the tone or rate of automated speech, which could affect comprehension. The small number of participants (N = 23) is another limitation that makes it not possible to generalize any of the results beyond the participant sample included in this study. The demographics reflected limited homogeneity among participants’ ethnicity (i.e., Caucasian) and gender (i.e., female). However, these characteristics mirror populations identified in the literature as experiencing low vision or blindness (Blewett et al., 2019). Recruiting participants during the COVID-19 pandemic posed challenges for the researchers. Several low vision support groups discontinued meeting during the pandemic, and leaders admitted to having limited communication with members, who may have had interest to participate. Additionally, the researchers did not inquire about the names of current prescriptions taken by participants. This data may have been useful to determine whether prior familiarity with prescription names may influence satisfaction scores or accuracy rates. The methodology did not include an inquiry of participants’ extent of experience, nor the type of training received by those who had prior familiarity with this technology.
The screening process used to identify participants’ functional hearing abilities is an additional limitation. Hearing abilities are necessary to receive auditory information, particularly in the field of visual impairments. The basic screening method used in this study did not parcel out the degree of hearing loss beyond functional, conversational hearing. The researchers recognize how any degree of hearing loss could potentially impact results and could cause participants to have difficulty hearing prescription names.
Furthermore, 21.7% (n = 5) of the sample indicated prior experience with the ScripTalk® device or the ScripTalk Mobile® app. Experience with this technology had a minimal impact on participants’ accuracy and satisfaction for Bottle 2. However, the overall impact was negligible when compared with the novel device users. Based on the study's methodology, the researchers did not explore the scope of their experience with the technology nor the type of or extent of training these participants may have received. The researchers recognize how prior experience could impact the report of satisfaction constructs or accuracy. The impact of experience on these factors warrants further investigation.
Future Research
While the study fills a gap in the literature, additional research should examine how the ScripTalk® device and other dedicated text-to-speech technologies support self-independence and medication safety among individuals with vision loss and blindness. Future studies should include a larger and more heterogeneous sample while considering device experience for the inclusion criteria. Future methodologies may incorporate participants’ personal prescriptions and investigate the impact of prior experience (e.g., extent of experience and training) on accuracy and device satisfaction. Future studies should compare users’ satisfaction, accuracy, and efficiency between the ScripTalk® device and the ScripTalk Mobile® app. Additional evidence can reveal benefits of these devices and garner end users’ perspectives to enhance the technologies. Though beyond this study's scope, additional research should explore the impact of age-related hearing abilities on accuracy and device satisfaction among older participants, as compared to younger participants who may have more familiarity with text to speech technology. Future research should also incorporate specific methodology to assess hearing abilities and rule out any degree of hearing loss as hearing deficits could impact study results. Exploring how cost and availability impact device use warrants further examination.
Implications
The findings offer implications for health care professionals, including vision specialists, occupational therapists, and certified vision rehabilitation therapists. Health care professionals should consider device features, auditory quality, and additional constructs, such as user satisfaction and accuracy, when prescribing and evaluating the effectiveness of audible prescription readers. Additional training may be necessary to assist end users to identify novel prescription names with these devices. Furthermore, this device may be especially useful for individuals who possess more than prescription.
Conclusion
In conclusion, participants perceived the ScripTalk® device to be easy to use, adjustable, comfortable, and lightweight. Participants noted the device offers a simplistic design with necessary and tactile features to support medication management. Auditory quality can present as a challenge to end users, particularly to accurately distinguish novel prescriptions and may influence user satisfaction and effectiveness. Health care professionals may need to provide additional training and practice opportunities with audible prescription readers to support consumers with low vision or blindness, particularly when new medications are prescribed. As audible prescription readers become more prevalent, additional research is needed to evaluate their impact on prescription management for individuals living with low vision and blindness.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
