A Virtual Agent to Support Individuals Living With Physical and Mental Comorbidities: Co-Design and Acceptability Testing

Abstract

Background Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on an individual’s levels of emotional distress, health outcomes, and associated health care utilization. As health care services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent (chatbot, conversational agent), which uses artificial intelligence (AI) to process the user’s written or spoken natural language and then to select or construct the corresponding appropriate responses. Objective This study aimed to co-design the content, functionality, and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (LTC; chronic pulmonary obstructive disease [COPD]) and then to assess the acceptability and system content. Methods We conducted 2 co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care. Results Adults (n=6) with a diagnosis of COPD and health professionals (n=5) specified 4 priority self-management scenarios for which they would like to receive support: at the time of diagnosis ( information provision ), during acute exacerbations ( crisis support ), during periods of low mood ( emotional support ), and for general self-management ( motivation ). From the scenario testing, 12 additional adults with COPD felt the system to be both acceptable and engaging, particularly with regard to internet-of-things capabilities. They felt the system would be particularly useful for individuals living alone. Conclusions Patients did not explicitly separate mental and physical health needs, although the content they developed for the virtual agent had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs.

Acceptability of an Embodied Conversational Agent for Type 2 Diabetes Self-Management Education and Support via a Smartphone App: Mixed Methods Study

“…Another important consideration is just how human an ECA should be. Although participants reported a clear preference for a human-like character, which is supported by previous research [ 15 ], her presentation of a backstory might be a step too far as it did not seem credible to some participants, possibly because of an uncanny valley phenomenon [ 25 ]. This finding is supported by previous research on other relational agents whose personality traits and life stories are enjoyed by some users, whereas, to others, the attempt at making them too human-like is not appealing [ 18 , 45 ].…”

“…Although the MDC app attempted to create an ECA with natural communication, this effort was impeded by difficulties using the speech recognition function; lack of inflection in Laura’s voice; and a limited number of random body movements, rather than ones that match the context of the conversation. Understanding natural behaviors, biological processes that underlie them, and creating efficient algorithms to implement a convincing simulation via an ECA is challenging but critical to the success of future ECA-based self-management support [ 15 , 35 ].…”

“…Research on the acceptability of ECAs in self-management of chronic conditions is still in its infancy, with a small number of studies reporting high levels of acceptability of ECA-based interventions [ 13 - 15 ]. Trust, empathy, and expertise have been cited as essential components of diabetes education and support [ 16 ].…”

Artificial Intelligence-Based Conversational Agents for Chronic Conditions: Systematic Literature Review

“…Article publication dates ranged from 2010 to 2020, with 80% (8/10) papers published from 2016 onward. Four studies were conducted in the United States [ 50 - 53 ], 2 in Spain [ 54 , 55 ], and 1 each in Australia [ 56 ], Canada [ 57 ], United Kingdom [ 58 ], and Korea [ 59 ]. Most studies were quasi-experimental and involved users testing and evaluating the conversational agents [ 50 , 51 , 54 , 56 - 59 ].…”

Companion robots for older people: importance of user-centred design demonstrated through observations and focus groups comparing preferences of older people and roboticists in South West England

“…Although our study was limited by recruiting older people from just one setting and roboticists from one university (although from varied educational and occupational backgrounds), we found marked differences in their views that need to be accounted for in the development of companion robots. If creative methods of coproduction are used,52 both groups would need to think more about why they liked certain features, and it is likely they would develop a new product that would be owned by this codesign group. Although there are no guarantees, a product so designed might have a higher chance of being liked by the wider population of older people.…”