Accepted for/Published in: JMIR Formative Research
Date Submitted: Jan 27, 2021
Date Accepted: Dec 20, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Co-Design of a Virtual Coach for Healthy Coping Interventions in Type 2 Diabetes Mellitus: A pilot study
ABSTRACT
Background:
Psychoeducational interventions to foster coping skills of patients in dealing with chronic conditions, such as Type 2 Diabetes Mellitus (T2DM), are keys to improve patients’ quality of life and well-being, and to ensure adherence to self-care recommendations for managing diabetes effectively referring to different aspects of a patient’s lifestyle. Despite the growing need for effective healthy coping digital interventions to support patients’ self-care and self-management, the design of digital interventions that are acceptable, usable, and engaging for the target users still represent a main challenge.
Objective:
This study presents an original approach to the co-design of a healthy coping intervention for diabetes to be delivered by a Virtual Coach (VC). The VC intervention was co-designed with the support of mental health experts and iteratively refined with participants, who played the role of standardized patients in simulated evaluation scenarios, to improve its quality in terms of user acceptability and engagement.
Methods:
By referring to the early phases of the ORBIT model, the healthy coping intervention was initially designed by two psychologists based on the main guidelines and recommendations for psychoeducational interventions for healthy coping with diabetes. The protocol was then refined with the support of three experts in the design of behavioral intervention technologies for mental health and well-being, who role-played three patients’ profiles receiving the virtual coaching intervention in a Wizard of Oz (WOZ) setting on WhatsApp. A refined version of the healthy coping protocol was then iteratively tested with a sample of 18 participants (Mage = 23.61; SD =1.975) who were assigned to play one out of six patients’ profiles in a slightly different WOZ evaluation setting. Participants provided quantitative and qualitative feedback post-intervention to report their experience with the VC. Clustering techniques on the logged interactions and dialogues between the VC and participants were collected and analysed to derive additional indications for future VC development.
Results:
Both quantitative and qualitative analyses showed that the digital healthy coping intervention was perceived as supportive, motivating, and able to trigger self-reflection on coping strategies by participants. Furthermore, analyses of the logged dialogues show that most of the participants played accurately the standardized patient’s profile assigned, confirming the validity and usefulness of this testing approach in preliminary assessments of behavioral digital interventions and protocols.
Conclusions:
This pilot study has outlined an original approach to the co-design and iterative testing of digital healthy coping interventions for T2DM, which proved effective in the definition and refinement of the initial protocol and of the user experience with a VC delivering the intervention, before real patients are directly involved in its further usage and testing.
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