Conversational Physical Activity Coaches for Spanish and English Speaking Women: A User Design Study

Abstract

Introduction: Digital technologies, including text messaging and mobile phone apps, can be leveraged to increase people's physical activity and manage health. Chatbots, powered by artificial intelligence, can automatically interact with individuals through natural conversation. They may be more engaging than one-way messaging interventions. To our knowledge, physical activity chatbots have not been developed with low-income participants, nor in Spanish—the second most dominant language in the U.S. We recommend best practices for physical activity chatbots in English and Spanish for low-income women.Methods: We designed a prototype physical activity text-message based conversational agent based on various psychotherapeutic techniques. We recruited participants through SNAP-Ed (Supplemental Nutrition Assistance Program Education) in California (Alameda County) and Tennessee (Shelby County). We conducted qualitative interviews with participants during testing of our prototype chatbot, held a Wizard of Oz study, and facilitated a co-design workshop in Spanish with a subset of our participants.Results: We included 10 Spanish- and 8 English-speaking women between 27 and 41 years old. The majority was Hispanic/Latina (n = 14), 2 were White and 2 were Black/African American. More than half were monolingual Spanish speakers, and the majority was born outside the US (>50% in Mexico). Most participants were unfamiliar with chatbots and were initially skeptical. After testing our prototype, most users felt positively about health chatbots. They desired a personalized chatbot that addresses their concerns about privacy, and stressed the need for a comprehensive system to also aid with nutrition, health information, stress, and involve family members. Differences between English and monolingual Spanish speakers were found mostly in exercise app use, digital literacy, and the wish for family inclusion.Conclusion: Low-income Spanish- and English-speaking women are interested in using chatbots to improve their physical activity and other health related aspects. Researchers developing health chatbots for this population should focus on issues of digital literacy, app familiarity, linguistic and cultural issues, privacy concerns, and personalization. Designing and testing this intervention for and with this group using co-creation techniques and involving community partners will increase the probability that it will ultimately be effective.

Examining Patient Engagement in Chatbot Development Approaches for Healthy Lifestyle and Mental Wellness Interventions: Scoping Review

“…Three of the included studies were RCTs [ 31 , 35 , 42 ], 4 were nonrandomized experimental studies [ 32 , 34 , 36 , 41 ], 3 were user-design and development studies [ 30 , 37 , 40 ], 3 were usability studies [ 38 , 39 , 43 ], 1 was a feasibility study [ 28 ], and 2 were proof-of-concept studies [ 29 , 33 ].…”

“…Fifteen of the 16 included studies reported the sample size; sample sizes ranged from 18 to 116 participants [ 34 , 37 ]. Participants’ age ranged from 12 to 69 years, with most participants being younger than 50 years old.…”

“…When a specific chronic disease group was described, populations included patients with celiac disease [ 42 ], diabetes [ 28 , 32 ], cancer [ 31 ], and sickle cell disease [ 38 ]. Where reported, the inclusion of female participants ranged from 31.4% to 100% [ 37 ]. Five studies involved an exercise intervention [ 34 , 35 , 37 , 39 , 43 ].…”

Applying the Digital Health Social Justice Guide

“…Methods included semi-structured interviews with stakeholders who received or participated in the care of Medicaid-insured pregnant people, brainstorming sessions to generate prototypes, and community events to test and improve prototypes (see additional resources in Table 2 for the guide). Figueroa et al ( 11 ) describes a virtual co-design session with low-income women for designing a physical activity chatbot. The session was co-led by study participants and included a digital whiteboard where participants could share their needs, wishes and design ideas for a comprehensive health app.…”

“…This study seeks to increase physical activity among English and Spanish-speaking patients with lower income, educational attainment, and/or disability who receive care for depression and diabetes at a public healthcare system in San Francisco ( 10 ). In addition, we identified examples from a physical activity chatbot study in low-income English and Spanish speaking women recruited from community health centers led by some of the authors (CAF and AA) ( 11 ). The aim of the examples was to connect social justice theory to real-world strategies and methods to increase the accessibility and relevance of digital health platforms to marginalized and underserved groups.…”