Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment

Dhakshenya Ardhithy Dhinagaran; Thirunavukkarasu Sathish; Tobias Kowatsch; Konstadina Griva; James Donovan Best; Lorainne Tudor Car

doi:10.2196/30435

Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment

JMIR Form Res. 2021 Nov 11;5(11):e30435. doi: 10.2196/30435.

Authors

Dhakshenya Ardhithy Dhinagaran¹, Thirunavukkarasu Sathish^{2

3}, Tobias Kowatsch^{4

5

6}, Konstadina Griva³, James Donovan Best¹, Lorainne Tudor Car^{1

7}

Affiliations

¹ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.
² Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
³ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
⁴ Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore.
⁵ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.
⁶ Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland.
⁷ Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.

PMID: 34762053
PMCID: PMC8663498
DOI: 10.2196/30435

Abstract

Background: The incidence of chronic diseases such as type 2 diabetes is increasing in countries worldwide, including Singapore. Health professional-delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. However, ongoing personalized guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology, such as conversational agents, are a potential alternative for the delivery of healthy lifestyle change behavioral interventions to the public.

Objective: We explored perceptions and experiences of Singaporeans on healthy living, diabetes, and mobile health (mHealth) interventions (apps and conversational agents). This study was conducted to help inform the design and development of a conversational agent focusing on healthy lifestyle changes.

Methods: This qualitative study was conducted in August and September 2019. A total of 20 participants were recruited from relevant healthy living Facebook pages and groups. Semistructured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analyzed in parallel by 2 researchers using Burnard's method, a structured approach for thematic content analysis.

Results: The collected data were organized into 4 main themes: use of conversational agents, ubiquity of smartphone apps, understanding of diabetes, and barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile apps as well as conversational agents unrelated to health care. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. Regarding barriers to healthy living, participants mentioned frequent dining out, high stress levels, lack of work-life balance, and lack of free time to engage in physical activity. In contrast, discipline, preplanning, and sticking to a routine were important for enabling a healthy lifestyle.

Conclusions: Participants in this study commonly used mHealth interventions and provided important insights into their knowledge gaps and needs in relation to changes in healthy lifestyle behaviors. Future digital interventions such as conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt healthy lifestyle behavior.

Keywords: chatbots; conversational agents; diabetes; healthy lifestyle change; mobile phone; prediabetes.

©Dhakshenya Ardhithy Dhinagaran, Thirunavukkarasu Sathish, Tobias Kowatsch, Konstadina Griva, James Donovan Best, Lorainne Tudor Car. Originally published in JMIR Formative Research (https://formative.jmir.org), 11.11.2021.