Deployment of ARCS Model and Utilization of Communication
Robot in Patient Education
Keitaro Ishiguro
1
, Yukie Majima
1
and Nobuhiro Sakata
2
1
Department of Sustainable System Sciences, Osaka Prefecture University,
1-1 Gakuencho Naka-ku, 599-8531, Sakai-shi, Osaka, Japan
2
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
Copyright
c
2016 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
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 (%)
u
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
Deployment of ARCS Model and Utilization of Communication Robot in Patient Education
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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