Making Come-Alive and Keeping Un-Alive: How People Relate to Self-Guided Web-Based Health Interventions.

Marianne T S Holter,Ottar Ness,Ayna B Johansen,Håvar Brendryen

doi:10.1177/1049732320902456

Abstract

Health interventions delivered online (self-guided web-based interventions) may become more helpful through a person-to-program “working alliance.” In psychotherapy, the working alliance signifies a therapeutically useful client–therapist relationship and includes an emotional bond. However, there exist no theories of how program users relate to online programs, or that explain a person-to-program bond theoretically. Addressing this gap, we conducted qualitative interviews with and collected program data from users of a self-guided web-based intervention. Taking a grounded theory approach, the analysis arrived at a model of relating based on two relational modes—making come-alive and keeping un-alive. Different combinations of these modes could describe a range of ways of relating to the program, including a nonsocial interaction, a semi-social interaction, and a semi-social relationship. A person-to-program bond is explained by the model as an experienced supportive social presence, enabled by making come-alive and a positive program interaction.

Highlights

Online health interventions may dramatically change how health care is provided by providing high-quality, individualized care without the expensive use of human resources, available to anyone with the access to the internet, anytime and everywhere
In the case of self-guided web-based interventions, the role of the therapist is assumed by the computer program, and the possibility of a person-toprogram alliance has intrigued researchers in the field (Barazzone et al, 2012; Baumel et al, 2017; Clarke et al, 2016; Ormrod et al, 2010; Peck, 2010)
The alliance is often defined as comprising three elements: (a) that client and therapist agree on the goals of therapy; (b) agreement on the therapeutic tasks toward that goal; and (c) the emotional bond, or “the nature of the human relationship between therapist and patient” (Bordin, 1979, p. 254)

Summary

Introduction

Online health interventions may dramatically change how health care is provided by providing high-quality, individualized care without the expensive use of human resources, available to anyone with the access to the internet, anytime and everywhere. One proposed working mechanism is a person-to-program “working alliance,” or collaborative relationship. People do seem to respond to computers as if they were other humans in a variety of situations, as demonstrated in a series of experiments conducted by Nass and Reeves (1996). Their overall finding was that participants interacted with computers in accordance with social norms for human interaction (e.g., being polite to computers or disliking computers that criticized other computers). Nass and Reeves call this the “media equation”—media equals real life—and explain it by observing that “people are not evolved to twentiethcentury technology,” and automatically behave socially toward anything that acts socially toward them (heading: “Why do people respond naturally and socially to media?”—third paragraph)

Objectives

Methods

Conclusion