Substance Use Screening using Virtual Agents

Abstract

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.

Clinical virtual reality: The state of the science.

“…One example of this can be seen in a recent randomized controlled trial (RCT) that demonstrated higher quality motivational interviewing skills in a real-world setting with clinicians who practiced with a VP following a U.S. Department of Veterans Affairs (VA) online training course compared with those who took the VA course plus time-equivalent (to VP practice) refresher training (Reger et al, 2020). VHs have also been created to produce online and mobile health care guides (Bickmore et al, 2020;Mozgai et al, 2020Mozgai et al, , 2021Rizzo et al, 2015) as clinical interviewers (Philip et al, 2017), sometimes with automated sensing of facial, gestural, and vocal behaviors useful for inferring the state of the user interacting with these VH entities (Rizzo et al, 2016) and for assessing empathetic behavior with clinical trainees (Yao et al, 2020). Recently, innovative efforts have appeared using embodied "body ownership" VH activities for addressing intimate partner violence (Gonzalez-Liencres et al, 2020;Matamala-Gomez et al, 2021), teaching self-compassion in persons with depression (Cebolla et al, 2019;Falconer et al, 2016), and promoting empathy in users who experience the challenges of another person via a virtual experience (Herrera et al, 2018).…”

The Impact of Virtual Humans on Psychosomatic Medicine

“…Moreover, they have been used to provide personalized interventions depending on patient data (46). Relational agent applications have spanned a wide variety of health care areas, including palliative care (48), preconception care (49), atrial fibrillation (50), cancer genetics (51), chronic illness (52), health behavior change (47), and psychiatry (53). Relational agents most commonly act as counselors but also as interviewers for health data or screens (50,51,54,55), health coaches (47), patient advocates and educators (49), and patient companions (56).…”

Co-design and evaluation of a smartphone-based mental health promotion and anti-stigma embodied conversational agent for church-affiliated Black adults

“…Prior work has demonstrated the effectiveness of ECAs in delivering health promotion interventions and effectively using health counseling techniques (e.g., Cognitive behavior therapy, Motivational Interviewing, etc.) to facilitate behavior change on a myriad of health topics, including but not limited to physical activity (King et al, 2020), genetic counseling (Zhou & Bickmore, 2022), preconception care (Jack et al, 2020), substance use (T. Bickmore et al, 2020b), and depression (Laranjo et al, 2018;Ring et al, 2016a). ECAs have been shown to successfully develop a positive therapeutic working alliance with users presenting a somewhat straightforward translation from in-person screening and counseling to a digital intervention (T. Bickmore & O'Leary, 2023).…”

“…Bickmore et al designed a tablet-based alcohol misuse screening ECA. They evaluated the system in two counterbalanced mixed methods validation studies with 57 participants, comparing the ECA to a human and an existing forms-based assessment (T. Bickmore et al, 2020a). Both studies demonstrated the validity of the ECA as a screening tool.…”

“…to effectively deliver health promotion interventions and leverage health counseling techniques (T. Bickmore et al, 2020b;T. Bickmore & O'Leary, 2023;Jack et al, 2020;King et al, 2020).…”