Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 19, 2018
Open Peer Review Period: Sep 22, 2018 - Nov 17, 2018
Date Accepted: Feb 17, 2019
(closed for review but you can still tweet)
Designing a Conversational Sequence for a Brief Motivational Interview for Stress Management on a Web-Based Text Messaging App: Qualitative Case Study
ABSTRACT
Background:
In addition to addiction and substance abuse, motivational interviewing (MI) is increasingly being integrated in treating other clinical issues such as mental health problems. Most of the many technological adaptations of MI, however, have focused on delivering the action-oriented treatment, leaving its relational component unexplored or vaguely described. This study intends an early design of a conversational sequence that considers both technical and relational components of MI for a mental health concern.
Objective:
This case study aims to design a conversational sequence for a brief motivational interview to be delivered by a Web-based text messaging application (“chatbot”), and to investigate its conversational experience with graduate students in their coping with stress.
Methods:
A brief conversational sequence was designed with varied combinations of MI skills to follow the four processes of MI. A Web-based text messaging app, Bonobot, was built as a research prototype to deliver the sequence in an online conversation. A total of 30 full-time graduate students who self-reported stress in regard of their school life was recruited for a survey of demographic information and perceived stress (PSS-10), and a semi-structured interview. Interviews were transcribed verbatim and analyzed by Braun and Clarke’s thematic method. Themes that reflect the process, impact of, and needs for the conversational experience are reported.
Results:
Participants had a high level of perceived stress (M=22.5, SD=5.0). Our findings include themes as follows: Evocative Questions and Clichéd Feedback; Self-Reflection and Potential Consolation; and Need for Information and Contextualized Feedback. Participants particularly favored the relay of evocative questions, but were less satisfied with the agent-generated reflective and affirming feedback that filled in-between. Discussing the idea of change was a good means of reflecting on themselves, and some of Bonobot’s encouragements related to graduate school life were appreciated. Participants suggested the conversation provide informational support, as well as more contextualized feedback.
Conclusions:
A conversational sequence for a brief motivational interview was presented in this case study. Participant feedback suggests sequencing questions and MI-adherent statements can facilitate a conversation for stress management, which may encourage a chance of self-reflection. More diversified sequences, along with more contextualized feedback, should follow to offer a better conversational experience and to confirm any empirical effect. Clinical Trial: n/a
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