Managing Chronic Conditions with a Smartphone-based Conversational Virtual Agent

Bickmore, Timothy; Kimani, Everlyne; Trinh, Ha; Pusateri, Alexandra; Magnani, Jared W.

doi:10.1145/3267851.3267908

Cited by 48 publications

(44 citation statements)

References 17 publications

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“…5 ECAs have already been used in medicine for the diagnosis, 6-8 prevention, 9,10 and treatment of medical conditions. 11,12 Taken together, the above studies tend to show that ECAs have a positive effect, as they rely on a virtual face-toface interaction, thus creating empathy for users and facilitating disclosure of negatively connoted symptoms such as addiction, depression, and post-traumatic stress disorder manifestations. [6][7][8] In addition, ECAs can significantly help healthcare delivery by saving physicians' time, diminishing the variability between professional interventions, providing 24/7 and easy-to-access support and monitoring of patients, and by managing huge volumes of medical data.…”

Section: Introductionmentioning

confidence: 99%

Trust and acceptance of a virtual psychiatric interview between embodied conversational agents and outpatients

et al. 2020

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Virtual agents have demonstrated their ability to conduct clinical interviews. However, the factors influencing patients' engagement with these agents have not yet been assessed. The objective of this study is to assess in outpatients the trust and acceptance of virtual agents performing medical interviews and to explore their influence on outpatients' engagement. In all, 318 outpatients were enroled. The agent was perceived as trustworthy and well accepted by the patients, confirming the good engagement of patients in the interaction. Older and less-educated patients accepted the virtual medical agent (VMA) more than younger and welleducated ones. Credibility of the agent appeared to main dimension, enabling engaged and non-engaged outpatients to be classified. Our results show a high rate of engagement with the virtual agent that was mainly related to high trust and acceptance of the agent. These results open new paths for the future use of VMAs in medicine.npj Digital Medicine (2020) 3:2 ; https://doi.

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Section: Introductionmentioning

confidence: 99%

Trust and acceptance of a virtual psychiatric interview between embodied conversational agents and outpatients

et al. 2020

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“…Only a few papers explicitly mentioned adopting theoretical frameworks to ground their design of VH [ 56 , 60 , 68 , 70 , 91 , 93 , 100 ]. The chronic care model was used to design VH for people with chronic illnesses [ 109 ]; the following 3 guidelines were adopted: facilitate communication between patients and providers, make patients aware of the latest care guidelines consistent with scientific evidence, and motivate patients to manage their health [ 60 ].…”

Section: Resultsmentioning

confidence: 99%

“…Four papers explicitly offered design guidelines for VH [ 57 , 60 , 64 , 71 ]. To design VH that can maintain long-term social relationships with end users (ie, relational agents), Bickmore et al [ 64 ] recommended developing a model of user-agent relationship; using relational behavior like social dialog, empathy, and humor; maintaining a memory of past interactions; and providing some variability in agent behavior and overall variability in the dialog structure.…”

Section: Resultsmentioning

confidence: 99%

Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis

Chattopadhyay¹,

Ma²,

Sharifi³

et al. 2020

J Med Internet Res

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Background Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. Objective The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. Methods Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. Results Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged — simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1). Conclusions We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.

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“…For example, a smartphone-based agent that counseled patients with atrial fibrillation on self-care management was evaluated in a clinical trial in which 120 patients with the condition were either provided with smartphones with the Agent and a heart rhythm monitor installed, or standard care, for 30 days. Compared to patients undergoing standard of care, patients using the Agent reported significantly higher quality of life at the end of the intervention period, based on a standard measure for patients with atrial fibrillation [33].…”

Section: Health Counseling By Virtual Agentsmentioning

confidence: 95%

Substance Use Screening using Virtual Agents

Bickmore

Rubin

Simon

2020

Proceedings of the 20th ACM International Conference on Intelligent Virtual Agents

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Alcohol, tobacco and illicit drug use cause significant loss quality of life, and represent a large economic burden on society. Standardized questionnaires have been developed to enable healthcare providers to screen individuals for substance misuse problems that may require intervention. Although routine use of these screeners is promoted in many healthcare organizations, their administration can be irregular and lack follow through. In addition, patients may be reluctant to report substance use. We report on the development and validation of a Virtual Agent designed to automate the administration of a standard substance use screening instrument. We report on two validation studies in which a total of 57 patients at a US Veterans Administration medical center were screened by the virtual agent, comparing first to a research assistant administering the standard screening questionnaire, and second to a standard computerized text-based implementation of the questionnaire. Assessment correlations between the agent and human administration were all significant, ranging from rho=0.83 to 0.94, with more disclosure to the agent. Correlations were lower for Study 2 (0.56-0.88), with participants significantly more satisfied with the Agent compared to the standard tool.

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Managing Chronic Conditions with a Smartphone-based Conversational Virtual Agent

Cited by 48 publications

References 17 publications

Trust and acceptance of a virtual psychiatric interview between embodied conversational agents and outpatients

Trust and acceptance of a virtual psychiatric interview between embodied conversational agents and outpatients

Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis

Substance Use Screening using Virtual Agents

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