JMIR Publications

ABSTRACT

Background:

The last decade has witnessed the rapid development of healthcare conversational agents (CAs); whereas, there are still great challenges in making healthcare CAs trustworthy and acceptable to patients.

Objective:

Focusing on the intelligent guidance CAs, this study aims to investigate how anthropomorphic cues influence patients’ perceived anthropomorphism and social presence of such CAs, and evaluate how these perceptions facilitate their trust building process as well as acceptance behavior.

Methods:

To test the research hypotheses, the video vignette methodology was used to evaluate patients’ perceptions and acceptance of various intelligent guidance CAs. The anthropomorphic cues of CAs were manipulated by a 3×2 within-subject factorial experiment with 103 participants, with the factors of agent appearance (high, medium and low anthropomorphic level) and verbal cues (human-like and machine-like verbal cues) as the within-subject variables.

Results:

The two-way repeated measures ANOVA analysis reported that the higher anthropomorphic level of agent appearance significantly increased mindful anthropomorphism (high level>medium level, 4.57 vs 4.27, P=.012; high level>low level, 4.57 vs 4.04, P < .001; medium level>low level, 4.27 vs 4.04, P =.040), mindless anthropomorphism (high level>medium level, 5.39 vs 5.01, P < .001; high level>low level, 5.39 vs 4.85, P < .001) and social presence (high level>medium level, 5.19 vs 4.83, P < .001; high level>low level, 5.19 vs 4.72, P < .001), and the higher anthropomorphic level of verbal cues significantly increased mindful anthropomorphism (4.83 vs 3.76, P < .001), mindless anthropomorphism (5.60 vs 4.57, P < .001) and social presence (5.41 vs 4.41, P < .001). Meanwhile, a significant interaction between the agent appearance and verbal cues (P=.004) was revealed. Second, the partial least squares (PLS) results indicated that privacy concerns were negatively influenced by social presence (β = -0.375, t = 4.494) and mindful anthropomorphism (β = -0.112, t = 1.970). Then, the privacy concerns (β = -0.273, t = 9.558), social presence (β = 0.265, t = 4.314) and mindless anthropomorphism (β = 0.405, t = 7.145) predicted the trust in CAs, which would further promote the patients’ intention to disclose information (β = 0.675, t = 21.163), intention to continuously use CAs (β = 0.190, t = 4.874) and satisfaction (β = 0.818, t = 46.783).

Conclusions:

The findings show that a high anthropomorphic level of agent appearance and verbal cues could improve the perceptions of mindful anthropomorphism and mindless anthropomorphism, as well as social presence. Furthermore, mindless anthropomorphism and social presence significantly promoted the patients’ trust in CAs, and mindful anthropomorphism and social presence decreased privacy concerns. It is also worth noting that trust was an important antecedent and determinant of patients’ acceptance of CAs, i.e., satisfaction, intention to disclose information and intention to continuously use CAs.