An Embodied Conversational Agent in an eHealth Self-management Intervention for Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Exploratory Study in a Real-life Setting

Silke Ter Stal; Joanne Sloots; Aniel Ramlal; Harm Op den Akker; Anke Lenferink; Monique Tabak

doi:10.2196/24110

An Embodied Conversational Agent in an eHealth Self-management Intervention for Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Exploratory Study in a Real-life Setting

JMIR Hum Factors. 2021 Nov 4;8(4):e24110. doi: 10.2196/24110.

Authors

Silke Ter Stal^{1

2}, Joanne Sloots³, Aniel Ramlal⁴, Harm Op den Akker^{1

2}, Anke Lenferink^{3

4}, Monique Tabak^{1

2}

Affiliations

¹ eHealth group, Roessingh Research and Development, Enschede, Netherlands.
² Biomedical Systems and Signals Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.
³ Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands.
⁴ Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.

PMID: 34734824
PMCID: PMC8603169
DOI: 10.2196/24110

Abstract

Background: Embodied conversational agents (ECAs) have the potential to stimulate actual use of eHealth apps. An ECA's design influences the user's perception during short interactions, but daily life evaluations of ECAs in health care are scarce.

Objective: This is an exploratory, long-term study on the design of ECAs for eHealth. The study investigates how patients perceive the design of the ECA over time with regard to the ECA's characteristics (friendliness, trustworthiness, involvement, expertise, and authority), small talk interaction, and likeliness of following the agent's advice.

Methods: We developed an ECA within an eHealth self-management intervention for patients with both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), which we offered for 4 months. Patients rated 5 agent characteristics and likeliness of following the agent's advice before use and after 3 and 9 weeks of use. The amount of patients' small talk interaction was assessed by log data. Lastly, individual semistructured interviews were used to triangulate results.

Results: Eleven patients (7 male and 4 female) with COPD and CHF participated (median age 70 years). Patients' perceptions of the agent characteristics did not change over time (P>.05 for all characteristics) and only 1 participant finished all small talk dialogues. After 3 weeks of use, the patients were less likely to follow the agent's advice (P=.01). The agent's messages were perceived as nonpersonalized and the feedback as inappropriate, affecting the agent's perceived reliability.

Conclusions: This exploratory study provides first insights into ECA design for eHealth. The first impression of an ECA's design seems to remain during long-term use. To investigate future added value of ECAs in eHealth, perceived reliability should be improved by managing users' expectations of the ECA's capabilities and creating ECA designs fitting individual needs.

Trial registration: Netherlands Trial Register NL6480; https://www.trialregister.nl/trial/6480.

Keywords: daily life evaluation; design; eHealth; embodied conversational agent; self-management.

©Silke ter Stal, Joanne Sloots, Aniel Ramlal, Harm op den Akker, Anke Lenferink, Monique Tabak. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 04.11.2021.