TY - JOUR
T1 - Acceptability of an embodied conversational agent for type 2 diabetes self-management education and support via a smartphone app
T2 - Mixed methods study
AU - Baptista, Shaira
AU - Wadley, Greg
AU - Bird, Dominique
AU - Oldenburg, Brian
AU - Speight, Jane
AU - The My Diabetes Coach Research Group
AU - Russell, Anthony William
N1 - Funding Information:
The MDC randomized controlled trial was conducted with funding from a National Health and Medical Research Council partnership grant (ID1057411), with additional financial and in-kind support provided by Diabetes Australia, Diabetes Queensland, Diabetes Victoria, Diabetes Western Australia, and Roche Diabetes Care. The development of the MDC app was the result of a collaboration among the University of Melbourne, Bupa Australia, The Bupa Foundation, and Clevertar. SB is supported by a postgraduate scholarship from the National Health and Medical Research Council, Australia, and Diabetes Australia. JS is supported by core funding to the Australian Centre for Behavioural Research in Diabetes, derived from the collaboration between Diabetes Victoria and Deakin University.
Publisher Copyright:
© Shaira Baptista, Greg Wadley, Dominique Bird, Brian Oldenburg, Jane Speight, The My Diabetes Coach Research Group. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 22.07.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/)
PY - 2020/7
Y1 - 2020/7
N2 - Background: Embodied conversational agents (ECAs) are increasingly used in health care apps; however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated. Objective: This study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app. Methods: A sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subsample of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants’ perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis. Results: Of the 93 intervention participants, 44 (47%) were women; the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional; (2) perceived support: emotional and motivational support; (3) embodiment preference acceptability of a human-like character; and (4) room for improvement: need for greater congruence between Laura’s words and actions. Conclusions: These findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences.
AB - Background: Embodied conversational agents (ECAs) are increasingly used in health care apps; however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated. Objective: This study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app. Methods: A sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subsample of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants’ perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis. Results: Of the 93 intervention participants, 44 (47%) were women; the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional; (2) perceived support: emotional and motivational support; (3) embodiment preference acceptability of a human-like character; and (4) room for improvement: need for greater congruence between Laura’s words and actions. Conclusions: These findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences.
KW - Embodied conversational agent
KW - MHealth
KW - Mobile apps
KW - Mobile phone
KW - Self-management
KW - Smartphone
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85088677299&partnerID=8YFLogxK
U2 - 10.2196/17038
DO - 10.2196/17038
M3 - Article
C2 - 32706734
AN - SCOPUS:85088677299
SN - 2291-5222
VL - 8
JO - JMIR mHealth and uHealth
JF - JMIR mHealth and uHealth
IS - 7
M1 - e17038
ER -