Use and Effect of Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Randomized Controlled Trial

Lean L Kramer; Lex van Velsen; Jenna L Clark; Bob C Mulder; Emely de Vet

doi:10.2196/33974

Use and Effect of Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Randomized Controlled Trial

JMIR Form Res. 2022 Apr 11;6(4):e33974. doi: 10.2196/33974.

Authors

Lean L Kramer¹, Lex van Velsen^{2

3}, Jenna L Clark⁴, Bob C Mulder⁵, Emely de Vet¹

Affiliations

¹ Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands.
² eHealth cluster, Roessingh Research and Development, Enschede, Netherlands.
³ Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands.
⁴ Center for Advanced Hindsight, Duke University, Durham, NC, United States.
⁵ Strategic Communication Group, Wageningen University & Research, Wageningen, Netherlands.

PMID: 35404255
PMCID: PMC9039822
DOI: 10.2196/33974

Abstract

Background: Embodied conversational agents (ECAs) have been proposed as a promising interaction modality for the delivery of programs focused on promoting lifestyle changes. However, it is not understood what factors influence the health effects of ECAs or their use.

Objective: We aimed to (1) identify whether ECAs could persuade community-dwelling older adults to change their dietary behavior and whether ECA use could decrease loneliness, (2) test the pathways to these effects, and (3) understand factors influencing the use of ECAs.

Methods: A randomized controlled trial was conducted. The intervention group received access to the PACO service for 8 weeks. The waitlist group started PACO use after waiting for 4 weeks. Two primary outcomes (eating behavior and loneliness) were assessed via online questionnaires at intake, upon joining the waitlist, after 4 weeks, and after 8 weeks. The third primary outcome (use) was assessed via data logs. Secondary outcomes were measured at the same time points, via questionnaires or an optional interview.

Results: In total, 32 participants completed the intervention. We found a significant correlation between use in minutes on the one hand, and perceived usefulness (r=0.39, P=.03) and enjoyment on the other (r=0.38, P=.03). However, these did not predict use in the full regression model (F_2,29=1.98, P=.16, R²=0.12). Additionally, PACO use did not lead to improvement in eating behavior (χ²₂=0.34, P=.85) or a decrease in loneliness (χ²₂=0.02, P=.99).

Conclusions: Our study did not provide any concluding evidence about factors that are linked to the use or health effects of ECAs. Future service design could benefit from either creating a functional design catering to the predominant stage in the precaution adoption process model of the targeted population, or by personalizing the service based on an intake in which the end user's stage is determined.

Trial registration: ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883.

International registered report identifier (irrid): RR2-10.2196/22186.

Keywords: eHealth; eating behavior; eating habits; embodied conversational agent; lifestyle change; older adult; online intervention; user experience.

©Lean L Kramer, Lex van Velsen, Jenna L Clark, Bob C Mulder, Emely de Vet. Originally published in JMIR Formative Research (https://formative.jmir.org), 11.04.2022.

Associated data

ClinicalTrials.gov/NCT04510883