JMIR Publications

ABSTRACT

Background:

Embodied conversational agents (ECAs) are animated computer characters that simulate face-to-face counseling. Because of their capacity to establish and maintain an empathic relationship, they are deemed to be a promising tool for starting and/or maintaining a healthy lifestyle.

Objective:

This review aims to identify current practices in designing and evaluating ECAs for coaching people towards a healthy lifestyle, and to provide an overview of their efficacy (on behavioral, knowledge and motivational parameters) and use (on usability, usage and user satisfaction parameters).

Methods:

We used the Arksey and O’Malley framework to conduct a scoping review. PsycINFO, PubMed and Scopus were searched with a combination of terms related to ‘ECA’ and ‘lifestyle’. Initially, 1.789 unique studies were identified; twenty were included.

Results:

Most often, ECAs targeted physical activity (n=16) and had the appearance of a middle-aged African-American woman (n=13). Multiple behavior change techniques (Mdn=3) and theories or principles (Mdn=3) were applied, but their interpretation and application were usually not reported. ECAs seemed to be designed for the end-user, rather than with the end-user. Stakeholders were usually not involved. Seven out of fifteen studies reported better efficacy outcomes for the intervention group, and five out of eight studies reported better use-related outcomes, as compared to the control group.

Conclusions:

ECAs are a promising tool for persuasive communication in the health domain. This review provided valuable insights into current developmental processes and recommends the use of human-centered, stakeholder-inclusive design approaches, and to report upon the design activities in a systematic and comprehensive manner. Gaps in knowledge were identified on the working mechanisms of intervention components, and the right timing and frequency of coaching.