Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.
Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore.
J Med Internet Res. 2021 Feb 17;23(2):e25060. doi: 10.2196/25060.
Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration.
With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent-delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent-patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings.
MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent-patient working alliance; (2) to offer hybrid (human- and conversational agent-supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX.
Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made.
This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a "team player" role but also show potential to improve health-relevant outcomes in chronic disease management.
慢性病的成功管理需要医疗保健专业人员、患者和家庭成员之间建立信任的合作关系。可扩展的对话代理旨在协助医疗保健专业人员，通过与患者及其家庭成员的日常生活联系，以可扩展的方式在支持这种合作方面发挥重要作用。然而，迄今为止，尚不清楚对话代理是否会被接受，以及它们是否能够支持这种多利益相关者的合作。
以儿童哮喘为例，这是慢性病管理的一个相关目标，本研究有以下目标：（1）描述 MAX 的设计，这是一种通过对话代理提供的哮喘干预措施，旨在支持医疗保健专业人员在日常生活中针对儿童-家长团队；（2）评估 MAX 的（a）覆盖范围、（b）对话代理-患者工作联盟、（c）接受程度、（d）干预完成率、（e）认知和行为结果，以及（f）初级和二级保健环境中医疗保健专业人员的人力投入和响应能力。
MAX 的设计旨在提高 10-15 岁哮喘儿童的认知技能（即哮喘知识）和行为技能（即吸入技术），并使医疗保健专业人员和家庭成员能够提供支持。为此，三个设计目标指导了开发：（1）建立对话代理-患者工作联盟；（2）提供混合（人工和对话代理支持）无处不在的辅导；（3）提供具有高体验价值的干预措施。计算机科学家、哮喘专家和患有哮喘的年轻患者及其父母组成的跨学科团队共同开发了这项干预措施。对话代理通过电子邮件与医疗保健专业人员沟通，通过移动聊天应用程序与患者沟通，通过短信与家庭成员沟通。在初级和二级保健环境中进行了一项单臂可行性研究，以评估 MAX。
结果表明，MAX 得到了总体上的积极评价，其覆盖范围为 49.5%（99/99 名招募和符合条件的患者-家庭成员团队中有 49 名参加），患者-对话代理工作联盟很强，所有相关利益相关者都高度接受。此外，MAX 导致认知和行为技能的提高，干预完成率为 75.5%。在 275 次辅导课程中，有 269 次（97.8%）由家庭成员支持患者。99.5%的对话轮次都是患者与对话代理之间进行的，而不是患者与医疗保健专业人员之间进行的，这表明 MAX 具有可扩展性。此外，医疗保健专业人员只需不到 4 分钟即可评估吸入技术，并且需要 3 天才能向患者提供相关反馈。提出了一些改进建议。
本研究首次提供了证据，证明设计为涉及医疗保健专业人员、患者和家庭成员的中介社交行为者的对话代理不仅在这种“团队成员”角色中被接受，而且还显示出在慢性病管理中改善健康相关结果的潜力。
