JMIR Publications

ABSTRACT

Background:

Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet, however, there is little research on their acceptability to date.

Objective:

The objectives of this study were to evaluate: (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults; and (2) the feasibility of the trial methods in preparation for a randomised controlled trial.

Methods:

A parallel, randomised pilot trial with a mixed design was conducted. Participants were adults aged 18–69 years with an underlying medical condition, or aged 70 years or older with a >24 MMSE score (i.e., at greater risk of developing severe COVID-19). Participants took part from their place of residence (20= independent living retirement village, 7= community dwelling, 3= nursing home). Participants were randomly allocated to the intervention or waitlist control group, who received the intervention one week later. The intervention involved completing cognitive behavioural (e.g., psychoeducation on stress awareness, deep breathing) and positive psychology exercises with a digital human facilitator on a website for at least 15-minutes per day over one week. The exercises used evidence-based strategies to improve loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioural observation data. Acceptability was evaluated using behavioural engagement data, the Friendship Questionnaire (adapted), self-report items and qualitative questions. Psychological outcomes were measured to evaluate feasibility of trial methods and included loneliness (UCLA Loneliness Scale), stress (Perceived Stress Scale), COVID-19 distress, well-being (Flourishing Scale), and affect (Scale of Positive and Negative Experiences).

Results:

30 participants (15 per group) were recruited. Participants were 22 older adults, and 8 younger adults with a health condition. 6 participants dropped out of the study. 24 participants’ data were analysed (12= intervention group; 12= waitlist group). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently. Slow internet speed reduced intervention feasibility for some participants. Suggestions for improvement included: additional content, tailoring to the population, and changes for the digital human’s design. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance.

Conclusions:

The digital human was a feasible and acceptable way of delivering a remote loneliness and stress intervention to at-risk adults during the COVID-19 pandemic. The intervention and trial methods were most feasible for people living independently. Support was found for further testing of digital humans to deliver remote psychological interventions. Findings will inform expansion of intervention content and the design of a randomised controlled trial to evaluate intervention effectiveness. Clinical Trial: Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000786998