Adherence and Engagement With a Cognitive Behavioral Therapy–Based Conversational Agent (Wysa for Chronic Pain) Among Adults With Chronic Pain: Survival Analysis

Abstract

Background Digital applications are commonly used to support mental health and well-being. However, successfully retaining and engaging users to complete digital interventions is challenging, and comorbidities such as chronic pain further reduce user engagement. Digital conversational agents (CAs) may improve user engagement by applying engagement principles that have been implemented within in-person care settings. Objective To evaluate user retention and engagement with an artificial intelligence–led digital mental health app (Wysa for Chronic Pain) that is customized for individuals managing mental health symptoms and coexisting chronic pain. Methods In this ancillary survival analysis of a clinical trial, participants included 51 adults who presented to a tertiary care center for chronic musculoskeletal pain, who endorsed coexisting symptoms of depression or anxiety (Patient-Reported Outcomes Measurement Information System score of ≥55 for depression or anxiety), and initiated onboarding to an 8-week subscription of Wysa for Chronic Pain. The study outcomes were user retention, defined as revisiting the app each week and on the last day of engagement, and user engagement, defined by the number of sessions the user completed. Results Users engaged in a cumulative mean of 33.3 sessions during the 8-week study period. The survival analysis depicted a median user retention period (i.e., time to complete disengagement) of 51 days, with the usage of a morning check-in feature having a significant relationship with a longer retention period (P=.001). Conclusions Our findings suggest that user retention and engagement with a CBT-based CA built for users with chronic pain is higher than standard industry metrics. These results have clear implications for addressing issues of suboptimal engagement of digital health interventions and improving access to care for chronic pain. Future work should use these findings to inform the design of evidence-based interventions for individuals with chronic pain and to enhance user retention and engagement of digital health interventions more broadly. Trial Registration ClinicalTrials.gov NCT04640090; https://clinicaltrials.gov/ct2/show/NCT04640090

Evaluating a Digital Mental Health Intervention (Wysa) for Workers’ Compensation Claimants

“…These high rates of engagement and retention indicate that the participants found the app features helpful for their everyday challenges 38 . The app’s CA has also demonstrated the ability to create a therapeutic alliance, which has also been positively linked with user engagement 39 …”

“… 38 The app’s CA has also demonstrated the ability to create a therapeutic alliance, which has also been positively linked with user engagement. 39 …”

“…38 The app's CA has also demonstrated the ability to create a therapeutic alliance, which has also been positively linked with user engagement. 39 Greater engagement with CAs has also been shown to lead to greater reductions in psychological distress, 31,[40][41][42][43] suggesting the benefits of using a digital psychosocial intervention for providing psychosocial support for injured workers.…”

Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence–Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis

“…A study involving Wysa users reported a significantly higher average improvement in depressive symptoms among the high-engagement Wysa user group compared to that of the low-engagement Wysa user group [ 19 ]. Additionally, Wysa has been found to improve mental health outcomes in chronic conditions [ 20 , 21 ], with high engagement and adherence [ 22 ]. It was found that users were able to establish a strong therapeutic alliance with the AI-based conversational agent that was comparable to a human therapeutic bond [ 23 ], further confirming the positive feedback from users [ 24 ].…”

Dialogue Management and Language Generation for a Robust Conversational Virtual Coach: Validation and User Study

“…Closer to our proposal, some works allow free language input. Wysa chatbot [ 41 , 42 ] works with free natural language or just a multiple-choice input, depending on the dialogue state. As for the output, unrestricted responses in complex dialogues can be found in EVA, MIRA and AMANDA [ 43 , 44 , 45 ], which are virtual medical assistants developed within the RASA ( , accessed on 20 January 2023) framework.…”