Ter Stal Silke, Sloots Joanne, Ramlal Aniel, Op den Akker Harm, Lenferink Anke, Tabak Monique
eHealth group, Roessingh Research and Development, Enschede, Netherlands.
Biomedical Systems and Signals Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands.
JMIR Hum Factors. 2021 Nov 4;8(4):e24110. doi: 10.2196/24110.
Embodied conversational agents (ECAs) have the potential to stimulate actual use of eHealth apps. An ECA's design influences the user's perception during short interactions, but daily life evaluations of ECAs in health care are scarce.
This is an exploratory, long-term study on the design of ECAs for eHealth. The study investigates how patients perceive the design of the ECA over time with regard to the ECA's characteristics (friendliness, trustworthiness, involvement, expertise, and authority), small talk interaction, and likeliness of following the agent's advice.
We developed an ECA within an eHealth self-management intervention for patients with both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), which we offered for 4 months. Patients rated 5 agent characteristics and likeliness of following the agent's advice before use and after 3 and 9 weeks of use. The amount of patients' small talk interaction was assessed by log data. Lastly, individual semistructured interviews were used to triangulate results.
Eleven patients (7 male and 4 female) with COPD and CHF participated (median age 70 years). Patients' perceptions of the agent characteristics did not change over time (P>.05 for all characteristics) and only 1 participant finished all small talk dialogues. After 3 weeks of use, the patients were less likely to follow the agent's advice (P=.01). The agent's messages were perceived as nonpersonalized and the feedback as inappropriate, affecting the agent's perceived reliability.
This exploratory study provides first insights into ECA design for eHealth. The first impression of an ECA's design seems to remain during long-term use. To investigate future added value of ECAs in eHealth, perceived reliability should be improved by managing users' expectations of the ECA's capabilities and creating ECA designs fitting individual needs.
Netherlands Trial Register NL6480; https://www.trialregister.nl/trial/6480.
具身对话代理（ECA）有潜力促进电子健康应用程序的实际使用。ECA的设计会在短时间互动中影响用户的感知，但在医疗保健领域对ECA的日常生活评估却很少。
这是一项关于用于电子健康的ECA设计的探索性长期研究。该研究调查了随着时间推移，患者如何根据ECA的特征（友好性、可信度、参与度、专业知识和权威性）、闲聊互动以及遵循代理建议的可能性来感知ECA的设计。
我们在一项针对慢性阻塞性肺疾病（COPD）和慢性心力衰竭（CHF）患者的电子健康自我管理干预措施中开发了一个ECA，并提供了4个月。患者在使用前以及使用3周和9周后对5个代理特征和遵循代理建议的可能性进行了评分。通过日志数据评估患者闲聊互动的量。最后，使用个体半结构化访谈对结果进行三角验证。
11名患有COPD和CHF的患者（7名男性和4名女性）参与了研究（中位年龄70岁）。患者对代理特征的感知随时间没有变化（所有特征的P>0.05），只有1名参与者完成了所有闲聊对话。使用3周后，患者遵循代理建议的可能性降低（P = 0.01）。代理的信息被认为是非个性化的，反馈不合适，影响了代理的感知可靠性。
这项探索性研究为电子健康的ECA设计提供了初步见解。ECA设计的第一印象在长期使用中似乎会持续存在。为了研究ECA在电子健康领域未来的附加价值，应通过管理用户对ECA能力的期望并创建符合个体需求的ECA设计来提高感知可靠性。
荷兰试验注册中心NL6480；https://www.trialregister.nl/trial/6480 。
