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Bruijnes M, Kesteloo M, Brinkman WP. Reducing social diabetes distress with a conversational agent support system: a three-week technology feasibility evaluation. Front Digit Health 2023; 5:1149374. [PMID: 37383944 PMCID: PMC10294428 DOI: 10.3389/fdgth.2023.1149374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/17/2023] [Indexed: 06/30/2023] Open
Abstract
Background People with diabetes mellitus not only have to deal with physical health problems, but also with the psycho-social challenges their chronic disease brings. Currently, technological tools that support the psycho-social context of a patient have received little attention. Objective The objective of this work is to determine the feasibility and preliminary efficacy of an automated conversational agent to deliver, to people with diabetes, personalised psycho-education on dealing with (psycho-)social distress related to their chronic illness. Methods In a double-blinded between-subject study, 156 crowd-workers with diabetes received a social help program intervention in three sessions over three weeks. They were randomly assigned to receive support from either an interactive conversational support agent (n=79) or a self-help text from the book "Diabetes burnout" as a control condition (n=77). Participants completed the Diabetes Distress Scale (DDS) before and after the intervention, and after the intervention, the Client Satisfaction Questionnaire (CSQ-8), Feeling of Being Heard (FBH), and System Usability Scale (SUS). Results Results indicate that people using the conversational agent have a larger reduction in diabetes distress (M=-0.305, SD=0.865) than the control group (M=0.002, SD=0.743) and this difference is statistically significant (t(154)=2.377, p=0.019). A hypothesised mediation effect of "attitude to the social help program" was not observed. Conclusions An automated conversational agent can deliver personalised psycho-education on dealing with (psycho-)social distress to people with diabetes and reduce diabetes distress more than a self-help book. Ethics Study Registration and Open Science This study has been preregistered with the Open Science Foundation (osf.io/yb6vg) and has been accepted by the Human Research Ethics Committee - Delft University of Technology under application number 1130. The data and analysis script are available: https://surfdrive.surf.nl/files/index.php/s/4xSEHCrAu0HsJ4P.
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Affiliation(s)
- Merijn Bruijnes
- Utrecht University School of Governance, Faculty of Law, Economics, and Governance, Utrecht University, Utrecht, Netherlands
- Department of Intelligent Systems, Faculty of Electrical Engineering, Mathematics & Computer Science, Delft University of Technology, Delft, Netherlands
| | - Mitchell Kesteloo
- Department of Intelligent Systems, Faculty of Electrical Engineering, Mathematics & Computer Science, Delft University of Technology, Delft, Netherlands
| | - Willem-Paul Brinkman
- Department of Intelligent Systems, Faculty of Electrical Engineering, Mathematics & Computer Science, Delft University of Technology, Delft, Netherlands
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Brandl L, van Velsen L, Brodbeck J, Jacinto S, Hofs D, Heylen D. Developing an eMental health monitoring module for older mourners using fuzzy cognitive maps. Digit Health 2023; 9:20552076231183549. [PMID: 37361430 PMCID: PMC10286164 DOI: 10.1177/20552076231183549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Effective internet interventions often combine online self-help with regular professional guidance. In the absence of regularly scheduled contact with a professional, the internet intervention should refer users to professional human care if their condition deteriorates. The current article presents a monitoring module to recommend proactively seeking offline support in an eMental health service to aid older mourners. Method The module consists of two components: a user profile that collects relevant information about the user from the application, enabling the second component, a fuzzy cognitive map (FCM) decision-making algorithm that detects risk situations and to recommend the user to seek offline support, whenever advisable. In this article, we show how we configured the FCM with the help of eight clinical psychologists and we investigate the utility of the resulting decision tool using four fictitious scenarios. Results The current FCM algorithm succeeds in detecting unambiguous risk situations, as well as unambiguously safe situations, but it has more difficulty classifying borderline cases correctly. Based on recommendations from the participants and an analysis of the algorithm's erroneous classifications, we propose how the current FCM algorithm can be further improved. Conclusion The configuration of FCMs does not necessarily demand large amounts of privacy-sensitive data and their decisions are scrutable. Thus, they hold great potential for automatic decision-making algorithms in mental eHealth. Nevertheless, we conclude that there is a need for clear guidelines and best practices for developing FCMs, specifically for eMental health.
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Affiliation(s)
- Lena Brandl
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
- Department of Human Media Interaction, University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
| | - Jeannette Brodbeck
- FHNW School of Social Work, Institute for Consulting, Coaching and Social Management, Olten, Switzerland
- Institute for Psychology, University of Bern, Bern, Switzerland
| | - Sofia Jacinto
- FHNW School of Social Work, Institute for Consulting, Coaching and Social Management, Olten, Switzerland
- Institute for Psychology, University of Bern, Bern, Switzerland
| | - Dennis Hofs
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
| | - Dirk Heylen
- Department of Human Media Interaction, University of Twente, Enschede, The Netherlands
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Albers N, Neerincx MA, Penfornis KM, Brinkman WP. Users' needs for a digital smoking cessation application and how to address them: A mixed-methods study. PeerJ 2022; 10:e13824. [PMID: 36003307 PMCID: PMC9394512 DOI: 10.7717/peerj.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/10/2022] [Indexed: 01/18/2023] Open
Abstract
Background Despite their increasing prevalence and potential, eHealth applications for behavior change suffer from a lack of adherence and from dropout. Advances in virtual coach technology provide new opportunities to improve this. However, these applications still do not always offer what people need. We, therefore, need a better understanding of people's needs and how to address these, based on both actual experiences of users and their reflections on envisioned scenarios. Methods We conducted a longitudinal study in which 671 smokers interacted with a virtual coach in five sessions. The virtual coach assigned them a new preparatory activity for quitting smoking or increasing physical activity in each session. Participants provided feedback on the activity in the next session. After the five sessions, participants were asked to describe barriers and motivators for doing their activities. In addition, they provided their views on videos of scenarios such as receiving motivational messages. To understand users' needs, we took a mixed-methods approach. This approach triangulated findings from qualitative data, quantitative data, and the literature. Results We identified 14 main themes that describe people's views of their current and future behaviors concerning an eHealth application. These themes relate to the behaviors themselves, the users, other parties involved in a behavior, and the environment. The most prevalent theme was the perceived usefulness of behaviors, especially whether they were informative, helpful, motivating, or encouraging. The timing and intensity of behaviors also mattered. With regards to the users, their perceived importance of and motivation to change, autonomy, and personal characteristics were major themes. Another important role was played by other parties that may be involved in a behavior, such as general practitioners or virtual coaches. Here, the themes of companionableness, accountability, and nature of the other party (i.e., human vs AI) were relevant. The last set of main themes was related to the environment in which a behavior is performed. Prevalent themes were the availability of sufficient time, the presence of prompts and triggers, support from one's social environment, and the diversity of other environmental factors. We provide recommendations for addressing each theme. Conclusions The integrated method of experience-based and envisioning-based needs acquisition with a triangulate analysis provided a comprehensive needs classification (empirically and theoretically grounded). We expect that our themes and recommendations for addressing them will be helpful for designing applications for health behavior change that meet people's needs. Designers should especially focus on the perceived usefulness of application components. To aid future work, we publish our dataset with user characteristics and 5,074 free-text responses from 671 people.
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Affiliation(s)
- Nele Albers
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
| | - Mark A. Neerincx
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands,Department of Perceptual and Cognitive Systems, Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Soesterberg, The Netherlands
| | - Kristell M. Penfornis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Willem-Paul Brinkman
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
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Davids J, Ashrafian H. AIM and mHealth, Smartphones and Apps. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chuang TY, Cheng W, Chiu YC, Fan YH, Chi CC, Chang CC, Liao CH. Free interactive counselling program in a mobile communication application for improving health education on indwelling ureteric stents after ureterorenoscopic lithotripsy: An observational study. Digit Health 2022; 8:20552076221117754. [PMID: 35959198 PMCID: PMC9358552 DOI: 10.1177/20552076221117754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective This study examines the potential benefit of an interactive counselling program via a mobile application (app), which can instantly provide patients with the necessary information and correct response regarding their condition. Methods We designed a free ‘Ureteric Stent Interactive Program’ for patients receiving ureterorenoscopic lithotripsy and provided the program to interested patients. Patient data were collected from medical records and depending on whether patients used our program, they were divided into two groups: ‘program-user’ and ‘non-user’. The differences between the groups were analysed using Fisher’s exact tests. Results Of the 70 patients, 50 elected to use the program. The program-user group was significantly younger (<60 years: 74% vs 15%, P<0.001) and had higher education levels (40% vs 5%, P = 0.004). All 50 patients in the program-user group reported being satisfied (32%) or very satisfied (68%) with the program. Patients over 60 years were significantly more satisfied with program (35.5% vs 6.3%, P = 0.04). Conclusions Younger patients with high education levels were more likely to use the app and improve their health knowledge. Using the program resulted in high satisfaction, especially among older patients. This study demonstrates the benefits of interactive application for educating patients regarding their health.
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Affiliation(s)
- Tzu-Yu Chuang
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch
| | - Weiming Cheng
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch
- Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Hsinchu
- Institute of Biopharmaceutical Science, School of Life Sciences, National Yang Ming Chiao Tung University, Hsinchu
- Department of Urology, Faculty of Medicine, National Yang Ming Chiao Tung University, Hsinchu
| | - Yi-Chun Chiu
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu
- Division of Urology, Department of Surgery, Heping Fuyou Branch, Taipei
- Department of Exercise and Health Sciences, University of Taipei, Taipei
| | - Yu-Hua Fan
- Department of Urology, Faculty of Medicine, National Yang Ming Chiao Tung University, Hsinchu
- Department of Urology, Taipei Veterans General Hospital, Taipei
| | - Chia-Chi Chi
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch
| | - Chang-Chi Chang
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch
- Department of Urology, Faculty of Medicine, National Yang Ming Chiao Tung University, Hsinchu
| | - Chia-Heng Liao
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch
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Abstract
This article reflects on the breadth of digital developments seen in primary care over time, as well as the rapid and significant changes prompted by the COVID-19 crisis. Recent research and experience have shone further light on factors influencing the implementation and usefulness of these approaches, as well as unresolved challenges and unintended consequences. These are considered in relation to not only digital technology and infrastructure, but also wider aspects of health systems, the nature of primary care work and culture, patient characteristics and inequalities, and ethical issues around data privacy, inclusion, empowerment, empathy and trust. Implications for the future direction and sustainability of these approaches are discussed, taking account of novel paradigms, such as artificial intelligence, and the growing capture of primary care data for secondary uses. Decision makers are encouraged to think holistically about where value is most likely to be added, or risks being taken away, when judging which innovations to carry forward. It concludes that, while responding to this public health emergency has created something of a digital 'big bang' for primary care, an incremental, adaptive, patient-centered strategy, focused on augmenting rather than replacing existing services, is likely to prove most fruitful in the longer term.
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Affiliation(s)
- Claudia Pagliari
- Global eHealth Group, Usher Institute, Edinburgh Global Health Academy & Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, UK
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Bendig E, Erb B, Meißner D, Bauereiß N, Baumeister H. Feasibility of a Software agent providing a brief Intervention for Self-help to Uplift psychological wellbeing ("SISU"). A single-group pretest-posttest trial investigating the potential of SISU to act as therapeutic agent. Internet Interv 2021; 24:100377. [PMID: 33816127 PMCID: PMC8005771 DOI: 10.1016/j.invent.2021.100377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/03/2020] [Accepted: 02/08/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Software agents are computer-programs that conduct conversations with a human. The present study evaluates the feasibility of the software agent "SISU" aiming to uplift psychological wellbeing. Methods: Within a one-group pretest-posttest trial, N = 30 German-speaking participants were recruited. Assessments took place before (t1), during (t2) and after (t3) the intervention. The ability of SISU to guide participants through the intervention, acceptability, and negative effects were investigated. Data analyses are based on intention-to-treat principles. Linear mixed models will be used to investigate short-term changes over time in mood, depression, anxiety. INTERVENTION The intervention consists of two sessions. Each session comprises writing tasks on autobiographical negative life events and an Acceptance- and Commitment Therapy-based exercise respectively. Participants interact with the software agent on two consecutive days for about 30 min each. RESULTS All participants completed all sessions within two days. User experience was positive, with all subscales of the user experience questionnaire (UEQ) M > 0.8. Participants experienced their writings as highly self-relevant and personal. However, 57% of the participants reported at least one negative effect attributed to the intervention. Results on linear mixed models indicate an increase in anxiety over time (β = 1.33, p = .001). Qualitative User Feedback revealed that the best thing about SISU was its innovativeness (13%) and anonymity (13%). As worst thing about SISU participants indicated that the conversational style of SISU often felt unnatural (73%). CONCLUSION SISU successfully guided participants through the two-day intervention. Moreover, SISU has the potential to enter the inner world of participants. However, intervention contents have the potential to evoke negative effects in individuals. Expectable short-term symptom deterioration due to writing about negative autobiographical life events could not be prevented by acceptance and commitment therapy-based exercises. Hence, results suggest a revision of intervention contents as well as of the conversational style of SISU. The good adherence rate indicates the useful and acceptable format of SISU as a mental health chatbot. Overall, little is known about the effectiveness of software agents in the context of psychological wellbeing. Results of the present trial underline that the innovative technology bears the potential of SISU to act as therapeutic agent but should not be used with its current intervention content. TRIAL-REGISTRATION The Trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Register (DRKS): DRKS00014933 (date of registration: 20.06.2018). Link: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014933.
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Affiliation(s)
- Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise Meitner Straße 16, 89081 Ulm, Germany
| | - Benjamin Erb
- Department of Computer Science, Institute of Distributed Systems, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Dominik Meißner
- Department of Computer Science, Institute of Distributed Systems, Ulm University, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise Meitner Straße 16, 89081 Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise Meitner Straße 16, 89081 Ulm, Germany
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Ireland D, Bradford D, Szepe E, Lynch E, Martyn M, Hansen D, Gaff C. Introducing Edna: A trainee chatbot designed to support communication about additional (secondary) genomic findings. PATIENT EDUCATION AND COUNSELING 2021; 104:739-749. [PMID: 33234441 DOI: 10.1016/j.pec.2020.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/23/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To support informed decision-making about reanalysis of clinical genomic data for risk of preventable conditions ('additional findings') by developing a chatbot (electronic genetic resource, 'eDNA'). METHODS Interactions in pre-test genetic counseling sessions (13.5 h) about additional findings were characterized using proponent, thematic and semantic analyses of transcripts. We then wrote interfaces to draw supplementary data from external genetics applications. To create Edna, this content was programmed using a chatbot framework which interacts with patients via speech-to-text. RESULTS Conditions, terms, explanations of concepts, and key factors to consider in decision making were all encoded into chatbot conversations emulating counseling session flows. Patient agency can be enhanced by prompted consideration of the personal and familial implications of testing. Similarly, health literacy can be broadened through explanation of genetic conditions and terminology. Novel aspects include sentiment analysis and collection of family history. Medical advice and the impact of existing genetic conditions were deemed inappropriate for inclusion. CONCLUSION Edna's successful development represents a movement towards accessible, acceptable and well-supported digital health processes for patients to make informed decisions for additional findings. PRACTICE IMPLICATIONS Edna complements genetic counseling by collecting and providing genomic information before or after pre-test consultations.
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Affiliation(s)
- David Ireland
- Australian e-Health Research Centre, CSIRO, UQ Health Sciences Building 901/16, Royal Brisbane and Women's Hospital, Herston, 4029, Australia.
| | - DanaKai Bradford
- Australian e-Health Research Centre, CSIRO, UQ Health Sciences Building 901/16, Royal Brisbane and Women's Hospital, Herston, 4029, Australia.
| | - Emma Szepe
- Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, 1G Royal Parade, Parkville, 3052, Australia; Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, 3052, Australia
| | - Ella Lynch
- Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, 1G Royal Parade, Parkville, 3052, Australia; Victorian Clinical Genetics Services, Flemington Road, Parkville, 3052, Australia; Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Australia.
| | - Melissa Martyn
- Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, 1G Royal Parade, Parkville, 3052, Australia; Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, 3052, Australia; Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Australia.
| | - David Hansen
- Australian e-Health Research Centre, CSIRO, UQ Health Sciences Building 901/16, Royal Brisbane and Women's Hospital, Herston, 4029, Australia.
| | - Clara Gaff
- Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, 1G Royal Parade, Parkville, 3052, Australia; Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, 3052, Australia; Murdoch Children's Research Institute, Flemington Road, Parkville, 3052, Australia.
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Davids J, Ashrafian H. AIM and mHealth, Smartphones and Apps. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Drissi N, Ouhbi S, Janati Idrissi MA, Fernandez-Luque L, Ghogho M. Connected Mental Health: Systematic Mapping Study. J Med Internet Res 2020; 22:e19950. [PMID: 32857055 PMCID: PMC7486675 DOI: 10.2196/19950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although mental health issues constitute an increasing global burden affecting a large number of people, the mental health care industry is still facing several care delivery barriers such as stigma, education, and cost. Connected mental health (CMH), which refers to the use of information and communication technologies in mental health care, can assist in overcoming these barriers. OBJECTIVE The aim of this systematic mapping study is to provide an overview and a structured understanding of CMH literature available in the Scopus database. METHODS A total of 289 selected publications were analyzed based on 8 classification criteria: publication year, publication source, research type, contribution type, empirical type, mental health issues, targeted cohort groups, and countries where the empirically evaluated studies were conducted. RESULTS The results showed that there was an increasing interest in CMH publications; journals were the main publication channels of the selected papers; exploratory research was the dominant research type; advantages and challenges of the use of technology for mental health care were the most investigated subjects; most of the selected studies had not been evaluated empirically; depression and anxiety were the most addressed mental disorders; young people were the most targeted cohort groups in the selected publications; and Australia, followed by the United States, was the country where most empirically evaluated studies were conducted. CONCLUSIONS CMH is a promising research field to present novel approaches to assist in the management, treatment, and diagnosis of mental health issues that can help overcome existing mental health care delivery barriers. Future research should be shifted toward providing evidence-based studies to examine the effectiveness of CMH solutions and identify related issues.
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Affiliation(s)
- Nidal Drissi
- Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, United Arab Emirates.,National School For Computer Science, Mohammed V University in Rabat, Rabat, Morocco
| | - Sofia Ouhbi
- Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Mounir Ghogho
- TICLab, International University of Rabat, Rabat, Morocco
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