The Perspectives of Women and Their Health-Care Providers Regarding Using an ECA to Support Mode of Birth Decisions

Abstract

This study used focus groups to assess the feasibility and acceptability of adapting an Embodied Conversational Agent (ECA) to support decision-making about mode of birth after previous cesarean. Twelve women with previous cesareans, and eight prenatal providers at an academic, tertiary-care medical center, viewed a prototype ECA and were asked to share feedback on the potential role in helping women prepare for decision-making. Both groups felt that although it was somewhat “robot-like,” the ECA could provide easy access to information for patients and could augment the visit with providers. Future work is needed to improve ECA visual appeal and clarify the role and timing for utilization of decision aids using ECA technology to enhance the shared decision-making process.

Chatbots to Improve Sexual and Reproductive Health: Realist Synthesis

“…Sharing information in this way may be valued over using search engines as users do not have to search, appraise sources, or pick out answers from longer passages of text [ 17 , 18 , 29 , 30 , 35 , 49 , 57 ]. Chatbots may also check user understanding and well-being at various points in the conversation [ 18 , 30 , 35 , 38 , 50 , 58 ]. This allows users to evaluate whether their needs are being met by the chatbot and may feel like a more authentic conversational flow.…”

“…Incorrect answers could generate health risks where users act on inappropriate clinical advice or signposting [59,60]. Studies CMOCs [17,18,29,30,35,48,49,57,61] When chatbots provide access to accurate information in digestible form (C), chatbots may be preferred to search engines (O), as the chatbot can eliminate steps to search and filter web-based health information (M) [18,31,58,62] When the language cues used, make chatbots feel uncanny (not quite human), like replying too quickly, misunderstanding, or overly formal language (C), then users can disengage from connecting with the Chatbot (O), as humans are sensitive to language cues that do not "feel right" (M) [18,30,35,38,50,53,58] When chatbots interact with users by prompting further questions and checking in with them (C), users engage for longer with the chatbot (C), because interaction drives the "conversation" between the user and chatbot forward and feels more human (M) [28,30] Where chatbots repeat information, either during a single session over repeated sessions (C), users may engage with the information provided (O), because repetition reinforces understanding (M) [30,52,58] Where chatbots use language that validates users' feelings and needs (C), this may engage users in chatbot use (O), because the chatbot offers a feeling of being understood (M) [54,56,62,63] Where chatbots give complex information on SRH topics (C), users may be able to understand the information more easily (O), because the information is given in a dialogical structure that shares information in short segments of "chunks" (O)…”

“…Studies CMOCs [35,38] When chatbots reference context-specific SRH a norms (such as SRH information seeking from peers or relatives) (C), then they may be engaging (O), because they feel familiar and relevant (M) [30,53,58,75] Where chatbots use emojis in a context-appropriate way (C), users enjoy the use of emojis (O), because they mimic conversations with friends and family (M) [35,37,38] Where users have formed a relationship with a chatbot (C), they may interact with it as if it were human including displays of empathy and inappropriate behavior (O), because the user may have personified the chatbot (M) [35,37] Where users have bonded with a chatbot (C), users may be disappointed by the limitations of a relationship with a chatbot (O), because chatbots cannot offer the depth of a human relationship (M) [37,38,57] When a chatbot persona resembles someone users feel comfortable discussing SRH with (C), then users may use the chatbot (O), because it relates to other experiences of positive SRH conversations (M) a SRH: sexual and reproductive health.…”

“…In these situations, chatbots may provide a rapid and timely assessment (eg, is emergency contraception needed) and signposting to wider services. Studies CMOCs [18,31,35,38,48,58] When chatbots offer 24-hour access to SRH a information (C), then users may find this convenient (O), because access to SRH information is not constrained by service opening times (M) [17,18,29,30,35,49,57] When chatbots provide immediate access to accurate information (C), users may stay engaged (O), as some users use chatbots in times of immediate need that require a fast response (M) a SRH: sexual and reproductive health.…”

“…"Actionability" has been identified as a key "affordance" of chatbots where users take action as a result of their conversation such as calling a helpline suggested by a chatbot [37]. Studies CMOCs [17,28,33,58] Where chatbots are used alongside human care (C), users find chatbots more acceptable (O), because users do not find chatbots appropriate as a complete alternative to human care (M) [18,34,36,44,46,50,51,84] Where chatbots are integrated into wider service networks (C), users' need for SRH services is better met (O), because users are signposted and supported in seeking other SRH services (M) a SRH: sexual and reproductive health.…”