Assessing the Feasibility of a Text-Based Conversational Agent for Asthma Support: Protocol for a Mixed Methods Observational Study

Abstract

Background Despite efforts, the UK death rate from asthma is the highest in Europe, and 65% of people with asthma in the United Kingdom do not receive the professional care they are entitled to. Experts have recommended the use of digital innovations to help address the issues of poor outcomes and lack of care access. An automated SMS text messaging–based conversational agent (ie, chatbot) created to provide access to asthma support in a familiar format via a mobile phone has the potential to help people with asthma across demographics and at scale. Such a chatbot could help improve the accuracy of self-assessed risk, improve asthma self-management, increase access to professional care, and ultimately reduce asthma attacks and emergencies. Objective The aims of this study are to determine the feasibility and usability of a text-based conversational agent that processes a patient’s text responses and short sample voice recordings to calculate an estimate of their risk for an asthma exacerbation and then offers follow-up information for lowering risk and improving asthma control; assess the levels of engagement for different groups of users, particularly those who do not access professional services and those with poor asthma control; and assess the extent to which users of the chatbot perceive it as helpful for improving their understanding and self-management of their condition. Methods We will recruit 300 adults through four channels for broad reach: Facebook, YouGov, Asthma + Lung UK social media, and the website Healthily (a health self-management app). Participants will be screened, and those who meet inclusion criteria (adults diagnosed with asthma and who use WhatsApp) will be provided with a link to access the conversational agent through WhatsApp on their mobile phones. Participants will be sent scheduled and randomly timed messages to invite them to engage in dialogue about their asthma risk during the period of study. After a data collection period (28 days), participants will respond to questionnaire items related to the quality of the interaction. A pre- and postquestionnaire will measure asthma control before and after the intervention. Results This study was funded in March 2021 and started in January 2022. We developed a prototype conversational agent, which was iteratively improved with feedback from people with asthma, asthma nurses, and specialist doctors. Fortnightly reviews of iterations by the clinical team began in September 2022 and are ongoing. This feasibility study will start recruitment in January 2023. The anticipated completion of the study is July 2023. A future randomized controlled trial will depend on the outcomes of this study and funding. Conclusions This feasibility study will inform a follow-up pilot and larger randomized controlled trial to assess the impact of a conversational agent on asthma outcomes, self-management, behavior change, and access to care. International Registered Report Identifier (IRRID) PRR1-10.2196/42965

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Evaluating the Potential and Pitfalls of AI-Powered Conversational Agents as Humanlike Virtual Health Carers in the Remote Management of Noncommunicable Diseases: Scoping Review

“…Some studies (4/43, 9%) used the System Usability Scale questionnaire to measure the system’s usability score and predominantly found high usability, with System Usability Scale scores of >70 [ 72 - 75 ]. Alternatively, multiple studies (10/43, 23%) used the subjective ratings of most of the participants to evaluate the feasibility and acceptability of CAs by applying indicators such as perceived usefulness [ 76 - 79 ], ease of use [ 78 , 80 ], user satisfaction [ 80 , 81 ], engagement rate [ 80 , 82 , 83 ], perceived closeness [ 73 ], and Net Promoter Score [ 84 ]. However, 2% (1/43) of the studies reported negative usability and acceptability outcomes, indicating unsatisfactory reliability, usability, and goal structure, which hindered health care professionals’ acceptance and trust [ 85 ].…”

A text-based conversational agent for asthma support: Mixed-methods feasibility study

“…An initial protocol paper outlined a study plan for developing and evaluating the feasibility of a chatbot designed to assist patients with asthma with risk self-assessment and self-management. 21 The user research and co-design phase of the project, which involved respiratory specialist physicians, asthma nurses, representatives from an asthma advocacy organisation and asthma patients, is described in Moradbakhti et al 22…”