JMIR Publications

ABSTRACT

Background:

Patient-reported outcome measure (PROM) completion is hindered by patient-level barriers—including motor, sensory, cognitive, and motivational constraints—that risk insufficient participation and non-response bias. While technology-enabled approaches such as multimodal speech assistance hold promise for reducing these barriers, assistance is a complex interaction: it can both alleviate and introduce barriers depending on how well it aligns with patients’ routines and needs.

Objective:

This qualitative study explores how patients perceive the advantages and disadvantages of AI-based speech assistance for PROM collection, focusing on how assistance functionalities interact with individual barriers and completion practices.

Methods:

We conducted semi-structured qualitative interviews with 96 psychosomatic and neurological rehabilitation outpatients, embedded in a pragmatic cross-randomised controlled trial. Participants completed PROMs with and without an AI-based speech assistance system offering speech output, speech input, and guidance by a socially interactive agent (SIA) that was physically, virtually, or voice-only embodied. The system was iteratively refined during data collection to address usability and performance issues. We included a broad sample to reflect real-world care settings, including patients without reported barriers. Using inductive content analysis (61 codes, grouped into 4 overarching and 9 subthemes), we examined perceived advantages and disadvantages of the three main assistance functionalities and multimodal interaction. Reporting followed the COREQ guideline.

Results:

The speech output function emerged as the most widely valued assistance feature, with many patients reporting improved concentration, question comprehension, and deeper engagement with item content. The social agent was described as making the interaction more engaging and less monotonous, by at the same time not evoking social pressure. Speech input was perceived as helpful by some, especially for those with motor impairments or a preference for verbal expression. However, each function also introduced challenges: speech output disrupted reading routines for some, the social agent was perceived as distracting or unnecessary by others, and speech input was criticised for recognition errors, inefficiency, and privacy concerns.

Conclusions:

AI-based speech assistance for PROM collection offers significant potential to reduce barriers and enhance patient engagement, but its effectiveness depends on alignment with individual needs, preferences and routines. While speech output proved broadly beneficial, speech input and socially interactive agents require careful design to avoid introducing new barriers, particularly for marginalised groups. Configurable, modular assistance systems that adapt to diverse user preferences and impairments are essential for equitable implementation. Future research should focus on inclusive co-design and longitudinal studies to refine these technologies for real-world clinical use. Clinical Trial: German Clinical Trail Register-ID: DRKS00035213