Especially with age, hospital admissions can become necessary at any time. People often tend to fully trust their doctors, nurses, and other health experts. This is great, but people should not give up their self-responsibility in the process. Health outcomes can be improved by focusing on patient empowerment, which means helping patients to gain control and to act well-informed concerning e.g., their medical treatment, the recovery process, and their well-being. We wanted to address this issue in a "gamified" way, as we think that the potential of supporting the older generation using digital tools is not yet exhausted.

What it does

The skill combines scientifically-based facts about patient empowerment with relevant patient safety tips. To achieve the best didactic learning effect, a quiz using example patients helps remembering – according to literature, answering questions is the best way to learn.

Through empowering and supporting potential patients, an additional safety barrier is built, the probability of patient harm due to avoidable mistakes shall be lowered and peoples' engagement in their own recovery can be increased.

By providing a skill with relevant content, we hope to make the use of digital technology more attractive to the older generation. The skill is deliberately focused, so as not to overwhelm beginners. Predominantly, yes/no answers are required. The spoken word is supported by pictures when using an Alexa device with a display. We also provide a learning video – accessible through the skill – that users can watch before taking the quiz and which helps consolidating the information further. This multi-modality further strengthens the learning effectiveness.

How we built it

We created the quiz with Voiceflow, the Alexa Skills Kit, and the Alexa Presentation Language. Based on insights from our work as a quality manager in a public health organization and a university professor, the foundations of the skill are based on one-year research including an ethics committee approval. It has then been evaluated qualitatively and quantitatively through a study with over 30 test users.

According to our literature research based on over 100 sources included in the published thesis, good health information must inter alia be: comprehensible, (gender) independent, target group oriented, and evidence-based. We chose the information sources about patient empowerment and patient safety according to these criteria. The facts about patient empowerment were developed by incorporating the EPF's "The Patients' Charter on Patient Empowerment", and the patient safety tips with the ANetPAS' guideline for a safe hospital stay They provide comprehensible and gender-neutral information. Both, the EPF and the ANetPAS, are (part of) independent networks consisting of health experts and organizations, with the aim to inter alia provide accessible evidence-based patient information.

As patient narratives are a valid tool to convey health information (Treadgold, 2014), and coherent, plausible contents are more memorable, we chose to use example patients in our skill. Examples help people in understanding unfamiliar concepts. Behavior tips must be explained in small steps to be understood (Fox, 2009) – which is exactly what we tried to do in our skill.

Challenges we ran into

Based on our didactic background, we know that multi-modality is important to ensure learners remember. Also, answering questions about learned content is more effective than reading the facts repeatedly – to avoid the dreaded _ forgetting curve _. The goal was to make the skill effective in this regard – showing a video, telling stories through examples, and letting users think about the contents by answering brief questions. In the scientific study, we originally sent the video link to all participants. However, for the new public skill, this was not possible. To achieve a similar effect, we had to find a way to show the video on Echo devices with a display; but at the same time provide a helpful solution for users without a display. We decided to push cards to the Alexa app, alongside an easy video URL that is pronounced slowly. Through careful dialog design, we also had to find a way to make it easy to re-watch the video if needed, while focusing users on learning through the quiz as well.

Accomplishments that we're proud of

Get Well Safely was originally developed as part of a master thesis at the Digital Healthcare degree program (St. Pölten University of Applied Sciences, Austria). Therefore, we have "real" scientific data that shows that the skill indeed increases patient empowerment. How did we measure this? We recruited over thirty test users: The participants had to fill out a questionnaire before and after practicing with the skill over a timespan of two weeks. The result: Patient empowerment levels significantly improved after practicing with the skill! On average, the patient empowerment score increased from 3.7 to 4.3 (on a scale of 1–5, with 5 being the highest score), which is a significant improvement according to the Wilcoxon Signed-Rank Test with a p < 0.001.

What we learned

A skill is a valuable way to convey health information and to improve health literacy. Our test users all rated the skill positively concerning intelligibility, usefulness, and interestingness.

You can read the full details of the scientific evaluation that proves the effectiveness of the skill to improve patient empowerment in the Master Thesis here.

What's next for Get Well Safely

It would be extremely useful and exciting to expand the skill with additional outpatient scenarios and to also provide tips for visiting the family doctor. In doing so, an even larger group could benefit from the use of the skill. It would continue improving patient empowerment and explore teaching health literacy through voice assistants.

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