Abstract

BackgroundEmbodied conversational agents (ECAs) are increasingly used in health care apps; however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated.ObjectiveThis study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app.MethodsA sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subsample of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants’ perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis.ResultsOf the 93 intervention participants, 44 (47%) were women; the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional; (2) perceived support: emotional and motivational support; (3) embodiment preference acceptability of a human-like character; and (4) room for improvement: need for greater congruence between Laura’s words and actions.ConclusionsThese findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences.Trial RegistrationAustralian New Zealand Clinical Trials Registry CTRN12614001229662; https://tinyurl.com/yxshn6pd

Highlights

  • Diabetes will affect 693 million people worldwide by 2045, most of whom will have type 2 diabetes (T2D) [1,2]

  • These findings suggest that an embodied conversational agent hemoglobin A1c (HbA1c) (ECA) is an acceptable means to deliver T2D self-management education and support

  • The ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences

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Summary

Introduction

Diabetes will affect 693 million people worldwide by 2045, most of whom will have type 2 diabetes (T2D) [1,2]. Many people with T2D are not able to achieve their recommended self-management targets [4]. Diabetes self-management education and support have been provided in person (one-to-one and group-based), with many trials and real-world studies demonstrating improved diabetes outcomes [5]. Ongoing in-person support for sustaining the recommended diabetes care targets is not feasible for most health care systems [4]. Embodied conversational agents (ECAs) are increasingly used in health care apps; their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated

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