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Personalization of Conversational Agent-Patient Interaction Styles for Chronic Disease Management: Two Consecutive Cross-sectional Questionnaire Studies

Gross, Christoph; Schachner, Theresa; Hasl, Andrea; Kohlbrenner, Dario; Clarenbach, Christian F; Wangenheim, Forian V; Kowatsch, Tobias (2021). Personalization of Conversational Agent-Patient Interaction Styles for Chronic Disease Management: Two Consecutive Cross-sectional Questionnaire Studies. Journal of Medical Internet Research, 23(5):e26643.

Abstract

Background: Conversational agents (CAs) for chronic disease management are receiving increasing attention in academia and the industry. However, long-term adherence to CAs is still a challenge and needs to be explored. Personalization of CAs has the potential to improve long-term adherence and, with it, user satisfaction, task efficiency, perceived benefits, and intended behavior change. Research on personalized CAs has already addressed different aspects, such as personalized recommendations and anthropomorphic cues. However, detailed information on interaction styles between patients and CAs in the role of medical health care professionals is scant. Such interaction styles play essential roles for patient satisfaction, treatment adherence, and outcome, as has been shown for physician-patient interactions. Currently, it is not clear (1) whether chronically ill patients prefer a CA with a paternalistic, informative, interpretive, or deliberative interaction style, and (2) which factors influence these preferences.

Objective: We aimed to investigate the preferences of chronically ill patients for CA-delivered interaction styles.

Methods: We conducted two studies. The first study included a paper-based approach and explored the preferences of chronic obstructive pulmonary disease (COPD) patients for paternalistic, informative, interpretive, and deliberative CA-delivered interaction styles. Based on these results, a second study assessed the effects of the paternalistic and deliberative interaction styles on the relationship quality between the CA and patients via hierarchical multiple linear regression analyses in an online experiment with COPD patients. Patients' sociodemographic and disease-specific characteristics served as moderator variables.

Results: Study 1 with 117 COPD patients revealed a preference for the deliberative (50/117) and informative (34/117) interaction styles across demographic characteristics. All patients who preferred the paternalistic style over the other interaction styles had more severe COPD (three patients, Global Initiative for Chronic Obstructive Lung Disease class 3 or 4). In Study 2 with 123 newly recruited COPD patients, younger participants and participants with a less recent COPD diagnosis scored higher on interaction-related outcomes when interacting with a CA that delivered the deliberative interaction style (interaction between age and CA type: relationship quality: b=-0.77, 95% CI -1.37 to -0.18; intention to continue interaction: b=-0.49, 95% CI -0.97 to -0.01; working alliance attachment bond: b=-0.65, 95% CI -1.26 to -0.04; working alliance goal agreement: b=-0.59, 95% CI -1.18 to -0.01; interaction between recency of COPD diagnosis and CA type: working alliance goal agreement: b=0.57, 95% CI 0.01 to 1.13).

Conclusions: Our results indicate that age and a patient's personal disease experience inform which CA interaction style the patient should be paired with to achieve increased interaction-related outcomes with the CA. These results allow the design of personalized health care CAs with the goal to increase long-term adherence to health-promoting behavior.

Keywords: COPD; chatbots; chronic conditions; chronic obstructive pulmonary disease; conversational agents; deliberative interaction; digital health; disease management; human-computer interaction; paternalistic interaction; physician-patient interaction styles

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Health Informatics
Uncontrolled Keywords:Health Informatics
Language:English
Date:26 May 2021
Deposited On:22 Nov 2021 10:22
Last Modified:26 Oct 2024 01:38
Publisher:JMIR Publications
ISSN:1438-8871
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.2196/26643
PubMed ID:33913814
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