Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment

Abstract

Background The incidence of chronic diseases such as type 2 diabetes is increasing in countries worldwide, including Singapore. Health professional–delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. However, ongoing personalized guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology, such as conversational agents, are a potential alternative for the delivery of healthy lifestyle change behavioral interventions to the public. Objective We explored perceptions and experiences of Singaporeans on healthy living, diabetes, and mobile health (mHealth) interventions (apps and conversational agents). This study was conducted to help inform the design and development of a conversational agent focusing on healthy lifestyle changes. Methods This qualitative study was conducted in August and September 2019. A total of 20 participants were recruited from relevant healthy living Facebook pages and groups. Semistructured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analyzed in parallel by 2 researchers using Burnard’s method, a structured approach for thematic content analysis. Results The collected data were organized into 4 main themes: use of conversational agents, ubiquity of smartphone apps, understanding of diabetes, and barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile apps as well as conversational agents unrelated to health care. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. Regarding barriers to healthy living, participants mentioned frequent dining out, high stress levels, lack of work-life balance, and lack of free time to engage in physical activity. In contrast, discipline, preplanning, and sticking to a routine were important for enabling a healthy lifestyle. Conclusions Participants in this study commonly used mHealth interventions and provided important insights into their knowledge gaps and needs in relation to changes in healthy lifestyle behaviors. Future digital interventions such as conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt healthy lifestyle behavior.

Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework

“…The conceptual framework development was informed by the 2 literature reviews and iterative consultations within the research team. Further refinements were also informed by the development of our CA prototype ( Precilla ) [ 63 , 64 ] as well as by presentations at clinical seminars and conferences. Multimedia Appendix 4 outlines the methodology applied in the development of the DISCOVER framework according to each step described by Jabareen [ 29 ].…”

“…Multimedia Appendix 4 outlines the methodology applied in the development of the DISCOVER framework according to each step described by Jabareen [ 29 ]. Multimedia Appendix 5 [ 63 , 64 ] presents the steps to develop CA Precilla mapped to the steps of the current version of the conceptual framework.…”

“…We subsequently applied the conceptual framework to develop a rule-based, text-based, smartphone-delivered CA prototype ( Precilla ) designed to support healthy lifestyle changes and educate participants about diabetes. The development, feasibility, and acceptability of Precilla have been reported elsewhere [ 63 , 64 ].…”

Public perceptions of a healthy lifestyle change conversational agent in Singapore: A qualitative study

“… 35 The researchers identified ‘incorporating the feedback of lived experiences’ as a valuable source of information in nurturing a positive body image and averting eating disorders. 35 Although some participants did mention how their personal experiences with diabetes affected their understanding of the condition in an earlier needs assessment study, 36 this was not raised in the current qualitative study and may be valuable when improving CA, Precilla . Another suggestion made by Park et al in the design of a CA for stress management was to have contextualised feedback and promote self-reflection to encourage healthier behaviours related to stress management.…”

Exploring the use of conversational agents in healthcare: an overview, conceptual analysis and case study

“…The design and development processes were integrated into each of the five steps outlined in the conceptual framework. Formative research was done in the form of a needs assessment comprising semi-structured interviews (chapter 6) and a subsequent pilot study to test the feasibility and acceptability of a conversational agent to deliver advice on healthy lifestyle change to the general public in Singapore (chapter 7) [198,282].…”