Establishing the computer–patient working alliance in automated health behavior change interventions

Automated Promotion of Technology Acceptance by Clinicians Using Relational Agents

“…Relational behaviors have been successfully used in animated conversational agents to build therapeutic alliance relationships with patients to increase satisfaction, engagement and adherence to medication and other health behavior regimens [9]. However, to our knowledge, this is the first time that automated relationship-building behavior by an interface agent has been used with clinicians, and the first time it has been successfully used to promote technology acceptance.…”

“…In order to make the system as acceptable and effective as possible with patients who had a wide range of health and computer literacy, we designed the interface to incorporate an animated virtual nurse who embodies best practices in health communication for patients with inadequate health literacy as well as incorporate the relational behaviors described above [9]. The agent is deployed on a wheeled kiosk with a touch screen display attached to an articulated arm that can be positioned in front of patients while they are in bed (Figure 2).…”

“…The agent's repertoire of nonverbal behavior includes a range of hand gestures (beats, emblematics, and deictics [11], including deictics at a document held by the agent), headnods, eyebrow raises, gazing at and away from the user, posture shifts [12], visemes, and facial displays of affect. User contributions to the conversation are made via a multiple-choice menu of utterances dynamically updated at each turn of the conversation [9].…”

“…Second, the agent explains how it was designed to provide benefits to the patients it interacts with as well as the nurses and the hospital (lines 6-8, 14, 18). Finally, a wide range of agent relational behavior was designed into the conversation to establish trust and rapport with nurses, following work that used this same behavior in automated health counselor agents to establish therapeutic alliance relationships with patients [9]. This included: close forms of greeting and farewell (calling the nurse by his or her given name, lines 1, 20); expressing happiness to see the nurse (line 3) and desire to work together with the nurse (line 8); social chat (lines 10-11); complimenting the nurse (lines 4-5); and desire to talk to the nurse again (lines 20).…”

“…Intelligent virtual agents that are explicitly designed to build rapport, trust, therapeutic alliance and other forms of working relationships with people have been referred to as "relational agents", and incorporate many of the same behaviors that people use for this purpose, including social chat, expressions of caring and empathy, agreement on values and beliefs, and nonverbal behaviors such as smiling, facial and gestural animation, and close proximity [8]. Relational agents have been used with diverse patient populations for a range of health education and behavior change interventions [6,9], and are also used in the hospital bedside patient education system ( Figure 2). To date, however, relational agents have not been used with professionals for the purpose of increasing technology acceptance in the workplace.…”