Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Nov 17, 2019
Date Accepted: Mar 29, 2020
Acceptability of an embodied conversational agent for type 2 diabetes self-management education and support via a smartphone app: a mixed-methods study.
ABSTRACT
Background:
Embodied conversational agents (ECAs) are increasingly used in healthcare applications (apps) however their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated.
Objective:
To evaluate the acceptability of the ECA ‘Laura’ used to deliver diabetes self-management education and support in the ‘My Diabetes Coach (MDC)’ app.
Methods:
A sequential mixed methods design was applied. Participants accessed the MDC app over a 6-month period and then completed questions assessing their interaction with, and attitudes to, the ECA. In-depth qualitative interviews were conducted with a sub-sample to explore users’ experiences of the ECA. Quantitative and qualitative data were interpreted through integrated synthesis.
Results:
Of the 93 participants, 44 (47.3%) were women, mean±SD age was 55±10 years and baseline HbA1c was 7.3±1.5%. Sixty-seven (72%) participants provided responses at 6-months post-baseline. Of these, most described Laura as being helpful (85%), friendly (85%), competent (84%), trustworthy (72%), and likable (60%). A substantial minority described Laura as not real (39%), boring (39%) and annoying (30%). Participants reported that interacting with Laura made them feel more motivated (43%), comfortable (36%), confident (21%), happy (16%) and hopeful (12%). Nineteen percent were frustrated by their interaction with Laura and 16% of participants reported that interacting with Laura made them feel guilty. Four themes were identified from the qualitative data (N=19): 1) Laura’s perceived role; 2) Laura’s value add to self-management; 3) Laura’s ‘human-like’ nature and 4) Laura’s shortcomings.
Conclusions:
These findings suggest an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing friendly, non-judgemental support is well-received. ECAs can provide enhanced support by increasing relational communication, providing ongoing emotional support, and alleviating some of the burden associated with T2D self-management. Nevertheless, the ECA’s communication can be improved with greater congruence between its verbal and non-verbal communication and by accommodating user preferences based on their existing expertise, expectations and management style . Clinical Trial: Australia New Zealand Clinical Trials Registry ID CTRN12614001229662
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