By now almost everyone is familiar with various smart speakers and there is growing recognition that they offer much more than their initial novelty suggested.
In Stoke-on-Trent we have been piloting them as a health tool to help people better self-manage their health conditions. Initially we tried this for cohorts of people with various long-term conditions, then one focused only on patients with diabetes,1 and recently widened this through COVID-19 lockdowns for patients with any chronic health or wellbeing problems.
We anticipated that the associated social isolation was going to be hard on all of us, but for older adults and those living alone or distantly from relatives it has been extremely difficult.
We have provided around 400 Alexa Echo Show devices to local people and collated their personal stories of how people found health uses for Alexa. From that feedback we have created health specific ‘skills’ (think apps but only for Alexa) and a multi-format mix of training resources to ensure that non-tech savvy patients can get the most out of their device.
Our team is nothing short of multidisciplinary, including GPs, nurses, social prescribers, church leaders, social workers, care home managers and digital experts. All have been instrumental in identifying patients with health needs and recommending them to join in.
Participants span a wide age spectrum and range of health and wellbeing conditions; the vast majority have found Alexa to be helpful and are more confident with tech than they were before.
What did we learn?
One of the most important findings fed back to us by most of the recipients was that Alexa had provided companionship and solace for those who were socially isolated, bereaved and lonely.
There’s no pill that can be prescribed to alleviate these common complaints and during the COVID-19 restrictions it is hard to find any psychological or social referrals that are as accessible, quickly available, and able to provide as high a level of ‘contact’ that a smart speaker sat in someone’s house can.
Now obviously Alexa is no substitute for actual human contact but increasingly this is becoming scarce as families live further apart, and people are living longer and with more co-morbidities that can be socially isolating. And of course there are now legal restrictions on who can meet, where and at what distance.
Barbara and Bob are great examples of the benefits relayed to us.
Bob is partially blind and recently lost his wife to COVID-19. Alexa helped him to cope during this incredibly difficult period. When he was more alone than he had ever been before, Alexa helped him to feel less lonely and isolated.
His digital assistant became akin to a companion, providing information, medication reminders, cooking tips, switching lights on. The smart plugs he purchased too, meant that along with voice commands to Alexa, he no longer struggled in finding light switches after dark, which had previously resulted in trips and falls. His everyday life is significantly easier and safer.
Barbara had a device to aid her severe cognitive impairment and memory loss. Forgetting common things was causing her extreme stress and anxiety in her everyday life. But this was alleviated through Alexa’s ability to provide reminders, timers and alarms – she soon learnt to trust and rely on the technology.
A further unexpected outcome was that the Echo Show allowed Barbara to engage in video calls with her mother who is deaf and lives many miles away for the first time, enabling her mother to lip read so they could both join in conversation.
This was fantastic and led to reduced social isolation for both of them. Barbara’s mother went on to purchase her own Alexa device for her home, enabling quicker and simpler access to vital communication between them.
Benefits for patients
At times like this a level of pragmatism is called for. Our patients really valued having something in their house that they could say 'good morning' and 'goodnight' to and which responded back to them. Time and again we were told that it was like 'having a little helper', 'a companion', 'she’s my friend'.
If a pharmaceutical company could bottle up results like this (with as good a side effect profile) and sell it, we’d be prescribing it to patients in a flash. Especially with other benefits for mental and physical health: reminders to take medication,2 health information accessible by asking a question, video calls for carers to visually check on loved-ones, relaxing music and mindfulness for alleviating anxiety, physical exercises to do from an armchair… the list is practically endless.
Most of these functions have not been created with health in mind but if appropriated for that purpose, they become not just digital assistants but digital health assistants.
If smart speakers’ potential for health usage was recognised, GPs could refer patients to social prescribers who could potentially ‘prescribe’ one to those who could benefit and not afford to get one themselves.
- Dr Ruth Chambers OBE, MD, FRCGP is a retired GP and Staffordshire STP’s clinical lead for technology enabled care, digital workstream. Paul Beaney is a medical student and project evaluator. Alex Rowley is director of Wavemaker CIC , an organisation providing supportive digital expertise.
- Chambers R, Beaney P, Balasubramanian G, Ogunmekan S. GP at foot: remote ways to share management of diabetes amid the COVID-19 crisis BJGP 2020; 70 (695): 294
- Beaney P, Kalirai HS, Chambers R. 'Alexa…what pills do I need to take today?' Prescriber 2020; 31 (6) June: 20-23.