Deployment of ARCS Model and Utilization of Communication

Robot in Patient Education

Keitaro Ishiguro

, Yukie Majima

and Nobuhiro Sakata

Department of Sustainable System Sciences, Osaka Prefecture University,

1-1 Gakuencho Naka-ku, 599-8531, Sakai-shi, Osaka, Japan

Department of ICT Education, Dokkyo Medical University, Shimotsuka, Tochigi, Japan

Key

words: Patient Education, Medication, ARCS Model, Communication Robot, Pepper.

Abstract: “Medication non-compliance” is a failure to take medication properly. Therefore, medication is necessary

for patients to be able to understand medication properly and to participate in treatment voluntarily with the

right motivation. For this study, we design medication education based on the ARCS model(Attention,

Relevance, Confidence, Satisfaction), which classifies concepts related to learning motivation (Keller, 1984),

and which incorporates utilization of the communication robot "Pepper".

1 INTRODUCTION

In Japan, where the population is expected to

decrease, the share of elderly people among the

population, which is about 30% in 2025, is expected

to reach about 40% in 2060. Moreover, the

proportion of elderly people living alone among the

elderly population is expected to increase for both

men and women (Statistics Bureau, 2014).

Therefore, the demand for elderly care is increasing

year by year. Furthermore, more than 60% of the

population has expressed a desire for recuperation at

home. Therefore, it is necessary to promote home

care and medical care (Ministry of Health, Labour

and Welfare, 2012). According to a 2010 survey,

elderly people take about 4.5 types of medicine per

day, on average, and have 3.5 disease types

(Akimoto, M. 2010). Depending on the pathology

and medicine, fragile elderly patients who have not

taken a medicine as doctors directed are 30–40%.

The cause is mainly their life alone and related

depression.

Advanced management using digital devices has

become more common because approximately 30%

of medical accidents at all medical institutions

(July–September 2014) are caused by medication.

However, burdens on medicine management of

elderly people living alone persist because few

elderly people know how to use digital devices.

(Foundation Japan Council for Quality Health Care

Medical Accident Prevention Division, 2015.)

Based on these circumstances, we examined the

educational method based on the ARCS model

(Keller, 1984), which classifies the concepts related

to learning motivation into "caution," "relevance,"

"confidence," and "satisfaction." Our purpose is that

elderly people, including those who live alone, can

also actively participate in medication therapy. In

other words, not only the understanding of the

educational content in the treatment education of

elderly patients, we examine patient education to

support voluntary action.

2 MEDICATION CONCEPT

2.1 Compliance with Medication

Compliance means taking medicines properly as

doctors prescribe. By compliance, the patients can

prevent recurrence of the disease, and can reduce

medical costs and improve the quality of life (QOL).

2.2 From Compliance to Adherence

Compliance has been called medication compliance.

However, medication compliance refers to the

following of a physician’s instructions. The matter

then is whether patients follow the doctor's

instructions or not.

However, the concept of medication adherence

Ishiguro, K., Majima, Y. and Sakata, N.

Deployment of ARCS Model and Utilization of Communication Robot in Patient Education.

DOI: 10.5220/0005774603710376

In Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2016) - Volume 5: HEALTHINF, pages 371-376

ISBN: 978-989-758-170-0

371

became widely known recently in Japan. Medication

adherence refers to a patient’s active participation in

treatment and is used in the active connotation,

whereas medication compliance carries passive

connotations.

In medication therapy, it is important for patients

to understand their disease and medicines they are

taking, rather than just being faithful to their doctor.

In actual medical scenes, the main idea has been

shifted from physicians’ initiative to medication

adherence on the patients’ initiative.

Furthermore, to improve medication adherence,

it is important to communicate well to let patients

listen to educational contents and build a trusting

relationships to perform medication assistance.

3 UTILIZATION OF

COMMUNICATION ROBOT

3.1 Communication with the Robot

Along with prevalence of smartphones, applications

that support medication management through oral

communication have been developed, and have been

downloadable easily at no charge. However, many

Japanese elderly people feel embarrassed to

communicate with inorganic, unmoving objects such

as smartphones.

On the contrary, with a moving robot, they say

that it is possible to communicate and receive

feedback just as humans and animals do. Therefore,

their reports say that robots reduce embarrassment.

Elderly people try to communicate actively with

robots.

3.2 Communication Robot in Japan

ROBOTALK

ApriPetit

Robovie-R Ver.3

Figure 1: Japanese communication robots.

The main communication robots in Japan are

described above. The upper left robot in Fig. 1,

named ROBOTALK (OKAMURA

CORPORATION, 2008-2013), is a robot made for

conversation with people. The upper right robot,

called PALRO (FUJISOFT, 2010-2015) can move

and recognize human faces. Finally, the bottom right

robot is a large communication robot named

Robovie-R Ver.3 (Vstone Corporation, 2010-2015).

Robovie-R3 is an everyday-use robot developed for

a robot-based communication research platform.

3.3 Emotion Recognition Robot Pepper

Various Japanese robots exist, but this time we

conducted patient education using the emotion

recognition robot Pepper. Pepper is a humanoid

robot that has been developed for symbiosis with

humans (Aldebaran; Softbank Robotics). Pepper can

recognize user emotions from facial expressions and

voices. It can move autonomously, having

conversations while moving around.

Reasons for using Pepper for this study include

the following: (1) it has a camera to ascertain

whether medication is properly administered by

photographing the pill case after medication, (2) its

affectionate human form attracts elderly people, (3)

it enables communication to let them listen to an

explanation related to treatment, (4) its rich

interactivity gives incentives by dance and song etc.,

(5) because of its rich communication function, it is

possible to maintain contact with the doctor while at

home, and (6) it is inexpensive.

The Pepper development environment is the

SDK called Choregraphe. It is possible to set the

program intuitively merely by dragging the mouse.

Figure 2: Benefits of utilizing Pepper.

4 ARCS MODEL

Keller conducted a detailed survey of the literature

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Figure 3: The medication advice example by communication robots.

related to learning motivation, and attempted

clustering of concepts based on the common

attributes. Results show that concepts related to

learning motivation are classifiable into four

categories: "attention," "relevance," "confidence,"

and "satisfaction" (ARCS model, 1984). This

classification enables to overview the key aspects of

a person's desire especially in the context of learning

motivation, and to create a strategy for stimulating

and maintaining the desire in the following four

areas.

1. Attention: winning the interest of the learner

and stimulating study curiosity

2. Relevance: meeting the personal needs and

goals to fill the positive needs of learners

3. Confidence: helping learners to realize and

have confidence that they can succeed, and success

can be obtained by their own ingenuity

4. Satisfaction: strengthening the achievement by

(internal and external) rewards

We perform patient education using Pepper

based on this ARCS model to improve medication

adherence.

5 FUNCTION PROPOSAL

5.1 Medication Advice

The basic flow of the medication assistance in

Pepper is shown in Fig. 3. First, it starts with the

medication time set, confirming the medication and

recording, with confirmation of the reasons for not

taking medicines and recording, and ending with a

dance to motivate the medication. The concept of the

ARCS model is added to make this flow more

effective.

First, to meet the first concept of "Attention,"

Pepper greets humans as the interaction of Fig. 3

starts, and administers a quiz about the medication,

for example about leftover medicine and side

effects. Although it is difficult to catch a person’s

attention by this alone, Pepper has rich interactivity,

such as BGM and posing, and quizzes can be

displayed on the tablet terminal on its chest, thereby

effectively maintains person’s interest and curiosity.

Next, as for "Relevance," when the correct

medication is continually taken, it tells the person

how many days or months the medication (success)

has been performed, thereby filling positive needs.

Category "Confidence" is performed after

"Relevance" by taking a picture of pill case after the

medication is taken and sending the photograph to

the doctor, thereby realizing continuation.

Finally, "Satisfaction" is performed by dances

and songs only after the correct medication is done.

Observation of the reaction to dance and song at

nursing care facilities showed that elderly people

hummed along with the song, especially with

famous songs, which can be said to be a sufficiently

intrinsic reward. This is one means of reinforcing the

achievement by giving incentives.

Deployment of ARCS Model and Utilization of Communication Robot in Patient Education

373

Figure 4: The diet advice example by communication robots.

5.2 Diet Advice

Medication advice of 5.1 is given based on the

concept of medication compliance rather than the

concept of medication adherence to emphasize

autonomy.

After considering the medication adherence and

receiving description of the proper medication, if the

patient understands side effects and so on and does

not feel like taking medication, then it is better to

improve the patient health condition mainly through

diet rather than through medication.

The diet advice is divisible into that given before

and after meals. In the first pre-dinner part, Pepper

should be programmed to react when the meal is

prepared at the table. Specifically, it reacts to words

such as "rice," "eat," and "ready." Then, it takes the

reaction to the meal and takes a photograph of the

meal using a camera. After sending the image to the

attending physician, it asks if you are eating three

meals at sufficient intervals. The reason for this

question is that if the energy is ingested frequently

little by little through more than three meals per day.

It helps to reduce fluctuation of the blood glucose

level. In addition, if the patient eats three meals at

appropriate intervals, then Pepper compliments the

patient. If not, then it encourages the patient to eat

three meals. After reaction of the question, it waits

until the end of the patient's meal.

In the postprandial part, the patient is addressed

by Pepper after a meal. Subsequently it asks the

second question, which is "whether you are full or

not." When the patient is full, it gives a quiz about

meals, if not, it waits until 20 min after the meal

started. For the patient to start feeling fullness, and if

it is already after 20 min, it advises the patient to eat

at intervals. After this question, it asks about the

patient’s recent physical condition as the third

question. If the physical condition of the patient is

good, then it compliments the patient on the

patient’s healthiness, and advises the patient about

common health problems of people of the same age,

and also gives an incentive of dance and song. When

the physical condition of the patient is bad and some

reason is suspected and readily apparent, it tells the

patient the cause and remedy along with diet and

light exercise. However, if the reason is not readily

apparent, Pepper records the patient’s voice and

transmits the audio file to the attending physician.

The ARCS model concept is to inform a patient

that Pepper is interested in the diet of the patient by

its reaction to the meal, to attract the patient’s

"attention," to give "relevance" by asking if three

meals are taken continuously and frequently. As for

the "confidence," if the patient can continue, then it

helps by ensuring and giving compliments on his

health. Finally, "satisfaction" is given by dances and

songs performed when physical conditions of the

patient are good.

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6 EVALUATION

Table 1: Attribute.

Gender N % (N=19)

Male 421.1

Female 15 78.9

age N % (N=19)

30's 15.3

40's 421.1

50's 421.1

60's 315.8

70's 526.3

80's 210.5

I performed a questionnaire about the application

(the medication advice based on the ARCS model)

in Kimotsuki Town, Kagoshima Prefecture, Japan in

October, 2015. Kimotsuki Town is predicted that the

depopulation and aging will advance so much and

the town demands the solutions to the problems with

the information appliance. The questionnaire caters

to the care receivers and care providers in the town

who are between 30 and 89 years old (Table 1).

The purpose of the questionnaire is an evaluation

of the Pepper’s medication advice which we

developed based on the ARCS model. They

evaluated “Pepper’s impression”, “attachment to

Pepper”, “motivation to learn”, “comprehension”,

“attention”, and “future” with 5 phases.(Scale: 1:

Lowest Value; 5: Highest Value, Table 2, 3)

All the results were positive evaluations (More

than 4). We understood that women have the high

evaluations for Pepper and its support than men

have. Furthermore, we interviewed them. It showed

that the communication with dementia elderly

person and Pepper was effective. This is because it

can accept the same topics again and again, and treat

an elderly person who needs intensive nursing care

or not fairly. We found that communication

technology using Pepper is expected in the field of

caring and nursing.

7 CONCLUSIONS

For problems of medication non-compliance, where

medication is not taken properly, there is a need for

medication education for patients to understand

medication correctly and to be able to participate in

the treatment voluntarily having appropriate

motivation.

For this study, based on the ARCS model that

classifies the concepts related to learning motivation

to design medication teaching, we examined how to

use a communication robot: "Pepper."

As future challenges, it is necessary to create and

evaluate a comprehensive application by adding

functions to exercise together or to remind patients

of their young age and so on because if the

implemented applications include only diet advice

and medication advice, it is very likely that the

learning effect will fade and patients will stop

communicating with Pepper. The program of

communication robot by the programmer or the

contents causes good and bad reactions. Therefore,

one must reflect that in the program by the form of

the implicit knowledge of effective communication

skill of caregivers or nurses. Specifically, it will be

integrated into a counseling technique called pacing,

to adjust the tone and speed of speech to the listener,

in Pepper.

After developing an application for which an

effect can be expected, we must conduct

experiments to target elderly people and examine

Table 2: 5 stage evaluation.

Question quite agree: 5 (%) agree: 4 (%) Whichever: 3 (%) against: 2 (%) quite against: 1 (%)

nknown (%)

Pepper's impression is good. 16 84.2 3 15.8 0 0.0 0 0.0 0 0.0 0 0.0

I want to meet with Pepper again. 14 73.7 5 26.3 0 0.0 0 0.0 0 0.0 0 0.0

When Pepp er cheers me up, I will drink the medicine. 8 42.1 9 47.4 2 10.5 00.0 00.0 00.0

I can get knowledge from Pepper 6 31.6 11 57.9 1 5.3 00.0 00.0 15.3

I listen to Pepper carefully. 10 52.6 9 47.4 0 0.0 0 0.0 0 0.0 0 0.0

When Pepp er cheers me up, I will be healthy. 9 47.4 8 42.1 2 10.5 00.0 00.0 00.0

Table 3: Average.

Question male female 30's 40's 50's 60's 70's 80's all

Pepper's impression is good. 4.5 4.9 5.0 4.8 5.0 5.0 4.6 5.0 4.8

I want to meet with Pepper again. 4.5 4.8 5.0 4.8 4.8 4.7 4.8 4.5 4.7

When Pepper cheers me up, I will drink the medicine. 4.0 4.4 4.0 4.5 4.5 4.0 4.0 5.0 4.3

I can get knowledge from Pepper 4.3 4.3 4.0 4.3 4.5 4.0 4.0 5.0 4.3

I listen to Pepper carefully. 4.3 4.6 5.0 4.8 4.8 4.0 4.2 5.0 4.5

When Pepper cheers, I will be healthy. 4.0 4.5 4.0 4.5 4.5 4.7 3.8 5.0 4.4

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375

whether their understanding on their disease and

medication status or health status is deepened or not.

ACKNOWLEDGEMENTS

As we proceeded with this study, we received

enthusiastic and polite guidance from staff members

of Fubright Communications Corporation. We

deeply appreciate their cooperation.

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