JMIR Publications

ABSTRACT

Background:

Successful management of chronic diseases requires a trustful collaboration between healthcare professionals, patients, and family members. Scalable conversational agents (CAs), designed to assist healthcare professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out into the everyday lives of patients and their family members. Until now, however, it has not been clear whether CAs, in such a role, would be accepted and whether they can support this multi-stakeholder collaboration.

Objective:

With asthma in children representing a relevant target of chronic disease management, this work has two objectives: (1) To describe the design of MAX, a CA-delivered asthma intervention that supports healthcare professionals targeting child-parent teams in their everyday lives; (2) To assess the (a) reach of MAX, (b) CA-patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of healthcare professionals in primary and secondary care settings.

Methods:

MAX was designed to increase cognitive skills (i.e. knowledge about asthma) and behavioral skills (i.e. inhalation technique) in 10-15-year-olds with asthma and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) To build a CA-patient working alliance; (2) To offer hybrid (human- and CA-supported) ubiquitous coaching; (3) To provide an intervention with a high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The CA communicates with healthcare professionals via email, with patients via a mobile chat app and with a family member via SMS. A single-arm feasibility study in primary and secondary care settings was conducted to assess MAX.

Results:

Results indicate an overall positive evaluation of MAX with respect to its reach (49.5% (49 out of 99) of recruited and eligible patient-family member teams participated), a strong patient-CA working alliance, and a high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the CA as opposed to between patient and healthcare professional, thus indicating the scalability of MAX. In addition, it took healthcare professionals less than four minutes to assess the inhalation technique and three days to deliver that feedback to the patients. Several suggestions for improvement were made.

Conclusions:

For the first time, this work provides evidence that CAs, designed as mediating social actors involving healthcare professionals, patients and family members, are not only accepted in such a “team player” role, but also show potential to improve health-relevant outcomes in chronic disease management.