JMIR Publications

ABSTRACT

Background:

Conversational agents (CAs) for chronic disease management are receiving increasing attention in academia and industry. However, long-term adherence to CAs is still a challenge and to be explored. Personalization of CAs has the potential to improve long-term adherence and, with it, user satisfaction, task efficiency, perceived benefits, and intended behaviour change. Research on personalized CAs has already addressed different aspects, such as personalized recommendations or anthropomorphic cues. However, detailed information on interaction styles between patients and CAs in the role of a medical healthcare professional is scant. Such interaction styles play an essential role for patient satisfaction, treatment adherence and outcome, as has been shown for physician-patient interactions. Currently, it is not clear (i) whether chronically ill patients prefer a CA with either a paternalistic, informative, interpretive, or deliberative interaction style, and (ii) which factors influence these preferences.

Objective:

The objective of this paper, comprising of two consecutive studies, is to investigate preferences for CA-delivered interaction styles by chronically ill patients.

Methods:

The first study was conducted paper-based and explored preferences of COPD-patients for paternalistic, informative, interpretive, and deliberative CA-delivered interaction styles. Based on these results, a second study assessed the effect of the paternalistic and deliberative interaction style on the relationship quality between the CA and patients via hierarchical multiple linear regression analyses in an online experiment with COPD patients. Patients’ socio-demographic and disease-specific characteristics served as moderator variables.

Results:

Study 1 with 117 COPD patients revealed a preference for the deliberative (50 out of 117) and informative (34 out of 117) interaction styles across demographic characteristics. The paternalistic style was preferred by persons with more severe COPD (GOLD 3/4 100%). Study 2 with 123 newly recruited COPD patients showed that younger persons and persons with a less recent COPD diagnosis scored higher on interaction-related outcomes when interacting with a CA that delivered the deliberative interaction style (Age and CA Type: Relationship Quality – b = -0.77 , 95% CI = [-1.37, -0.18]; Intention to Continue Interaction – b = -0.49, 95% CI = [-0.97; -0.01]; Working Alliance Attachment Bond – b = -0.65, 95% CI = [-1.26; -0.04]; Working Alliance Goal Agreement – b = -0.59, 95% CI = [-1.18; -0.01]; Recency of COPD diagnosis and CA Type: Working Alliance Goal Agreement – b = 0.57, 95% CI = [0.01; 1.13]).

Conclusions:

Our results indicate that age and a patient's personal disease experience inform which interaction style the patient should be paired with to achieve increased interaction related outcomes with the CA. These results allow to design personalized healthcare CAs with the goal to increase long-term adherence to health-promoting behavior.