Abstract
Stress is a prevalent issue amongst patients with chronic conditions. As eHealth interventions are gaining importance, it becomes more relevant to invoke the possibilities from the eHealth technology itself to provide motivational acts during experiences of stress as to enhance adherence to the intervention. Embodied Conversational Agents (ECA's) also known as ‘robots on screen’ can potentially provide a remedy. Within our eHealth experiment we applied a between-subjects design and experimentally studied the difference in appraisal of motivation and guidance. We deployed a functionally modest, monologue-style ECA and compared them with textual guidance. This way, we filtered out the considerable positive impact of interactive features that go along with dialogue-style ECA's. The study was carried out amongst eHealth users of which half were deliberately put in a stressful pre-condition. The rationale was two-sided; first, we hypothesized that it would induce a need for motivational support. Second, it would provide a fair representation of eHealth users in real life. Furthermore, we investigated hypothesized positive effects from a gender match between participant and ECA. The results demonstrated preferential ECA effects compared to text but only in the no stress conditions. Although our set-up controlled for user distraction by putting the facilitating ECA in a pane separate from the eHealth environment, we suspect that the enduring visual presence of the ECA during task completion had still inhibited distressed users. Discussing this phenomenon, our stance is that the hypothesis that ECA support is always superior to textual guidance is open for re-evaluation. Text may sometimes serve users equally well because it lacks human-like aspects that in stressful circumstances can become confrontational. We discuss the potential of ECA's to motivate, but also elaborate on the caveats. Further implications for the ECA, intervention adherence, and eHealth study fields are discussed in relation to stress.
Highlights
It is well-established finding that patients with chronic health conditions face elevated levels of stress
We found a prominent effect of the gender of the participant interacting with the empathic virtual therapist (ECA); female participants scored significantly higher than their male counterparts on both involvement and rapport
Our main ambition for studying the effectiveness of a monologuestyle ECA acting as an adjunct to a self-guided eHealth context was its potential to deliver higher evaluated user guidance and support than plain text
Summary
It is well-established finding (see e.g. Vancampfort et al, 2017) that patients with chronic health conditions face elevated levels of stress. Huygens et al (2016) refer to a patient's story measuring blood data as a routine, becoming more aware of his condition, and notifying this as a highly unpleasant experience Another germane study (Kelders et al, 2013) reports on a group of users who dropped out from an intervention designed to reduce depressive complaints. Note that -from a treatment perspective-this lesson was as a key event for reaping the benefits from the eHealth intervention These studies suggest that eHealth self-management - a sensible activity from a medical perspective- is often a daunting task from an emotional and personal perspective. In such as stressful situation, many patients lose motivation to continue using their eHealth interventions. Intrinsic patient motivation starts to wane and external support has to be invoked
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