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Ter Stal S, Sloots J, Ramlal A, Op den Akker H, Lenferink A, Tabak M. An Embodied Conversational Agent in an eHealth Self-management Intervention for Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Exploratory Study in a Real-life Setting. JMIR Hum Factors 2021; 8:e24110. [PMID: 34734824 PMCID: PMC8603169 DOI: 10.2196/24110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/17/2020] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background 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. Objective 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. Methods 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. 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. Conclusions 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. Trial Registration Netherlands Trial Register NL6480; https://www.trialregister.nl/trial/6480
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Affiliation(s)
- Silke Ter Stal
- 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
| | - Joanne Sloots
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Aniel Ramlal
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Harm Op den Akker
- 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
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Monique Tabak
- 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
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Digital Health Interventions among People Living with Frailty: A Scoping Review. J Am Med Dir Assoc 2021; 22:1802-1812.e21. [PMID: 34000266 DOI: 10.1016/j.jamda.2021.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Digital health interventions (DHIs) are interesting resources to improve various health conditions. However, their use in the older and frail population is still sparse. We aimed to give an overview of DHI used in the frail older population. DESIGN Scoping review with PRISMA guidelines based on Population, Concept, and Context. SETTING AND PARTICIPANTS We included original studies in English with DHI (concept) on people described as frail (population) in the clinical or community setting (context) and no limitation on date of publication. We searched 3 online databases (PubMed, Scopus, and Web of Science). MEASURES We described DHI in terms of purpose, delivering, content and assessment. We also described frailty assessment and study design. RESULTS We included 105 studies that fulfilled our eligibility criteria. The most frequently reported DHIs were with the purpose of monitoring (45; 43%), with a delivery method of sensor-based technologies (59; 56%), with a content of feedback to users (34; 32%), and for assessment of feasibility (57; 54%). Efficacy was reported in 31 (30%) studies and usability/feasibility in 57 (55%) studies. The most common study design was descriptive exploratory for new methodology or technology (24; 23%). There were 14 (13%) randomized controlled trials, with only 4 of 14 studies (29%) showing a low or moderate risk of bias. Frailty assessment using validated scales was reported in only 47 (45%) studies. CONCLUSIONS AND IMPLICATIONS There was much heterogeneity among frailty assessments, study designs, and evaluations of DHIs. There is now a strong need for more standardized approaches to assess frailty, well-structured randomized controlled trials, and proper evaluation and report. This work will contribute to the development of better DHIs in this vulnerable population.
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Ter Stal S, Broekhuis M, van Velsen L, Hermens H, Tabak M. Embodied Conversational Agent Appearance for Health Assessment of Older Adults: Explorative Study. JMIR Hum Factors 2020; 7:e19987. [PMID: 32886068 PMCID: PMC7501582 DOI: 10.2196/19987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Embodied conversational agents (ECAs) have great potential for health apps but are rarely investigated as part of such apps. To promote the uptake of health apps, we need to understand how the design of ECAs can influence the preferences, motivation, and behavior of users. OBJECTIVE This is one of the first studies that investigates how the appearance of an ECA implemented within a health app affects users' likeliness of following agent advice, their perception of agent characteristics, and their feeling of rapport. In addition, we assessed usability and intention to use. METHODS The ECA was implemented within a frailty assessment app in which three health questionnaires were translated into agent dialogues. In a within-subject experiment, questionnaire dialogues were randomly offered by a young female agent or an older male agent. Participants were asked to think aloud during interaction. Afterward, they rated the likeliness of following the agent's advice, agent characteristics, rapport, usability, and intention to use and participated in a semistructured interview. RESULTS A total of 20 older adults (72.2 [SD 3.5] years) participated. The older male agent was perceived as more authoritative than the young female agent (P=.03), but no other differences were found. The app scored high on usability (median 6.1) and intention to use (median 6.0). Participants indicated they did not see an added value of the agent to the health app. CONCLUSIONS Agent age and gender little influence users' impressions after short interaction but remain important at first glance to lower the threshold to interact with the agent. Thus, it is important to take the design of ECAs into account when implementing them into health apps.
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Affiliation(s)
- Silke Ter Stal
- 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
| | - Marijke Broekhuis
- 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
| | - Lex van Velsen
- 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
| | - Hermie Hermens
- 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
| | - Monique Tabak
- 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
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Lawless MT, Archibald MM, Ambagtsheer RC, Kitson AL. Factors influencing communication about frailty in primary care: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:436-450. [PMID: 31551158 DOI: 10.1016/j.pec.2019.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/14/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To summarise the available evidence on the factors influencing communication about frailty in the primary care setting. METHODS We conducted a scoping review, searching five electronic databases (PubMed, Scopus, CINAHL, PsycINFO, and ProQuest) for studies addressing communication about frailty in primary care practice. Reference list and grey literature searching was conducted to identify additional articles. A narrative descriptive method was used to synthesise the findings. RESULTS The search identified 3185 articles and 37 were included in the review. We identified five categories of factors influencing communication about frailty at the consumer, healthcare provider, and system levels: (1) consumer perceptions, information needs, and communication preferences; (2) healthcare providers' knowledge, capacities, and attitudes; (3) clinical communication skills and training; (4) availability of information and communication technologies; and (5) care coordination, collaboration, and case management. CONCLUSION Findings offer considerations for the design and delivery of initiatives to improve communication about frailty in primary care both at the local clinical level and at the broader level of healthcare service delivery. PRACTICE IMPLICATIONS Healthcare providers and systems require practical, evidence-informed guidance regarding the development of a systematic approach to the quality and timing of communication about frailty in healthcare encounters.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.
| | - Mandy M Archibald
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
| | | | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
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Gwyther H, van Velsen L, Shaw RL, D'Avanzo B, Bujnowska-Fedak M, Kurpas D, Szwamel K, Van't Klooster JW, Holland C. The use of technology in the context of frailty screening and management interventions: a study of stakeholders' perspectives. BMC Med Inform Decis Mak 2019; 19:110. [PMID: 31186018 PMCID: PMC6560850 DOI: 10.1186/s12911-019-0828-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/29/2019] [Indexed: 11/22/2022] Open
Abstract
Background Health and social care interventions show promise as a way of managing the progression of frailty in older adults. Information technology could improve the availability of interventions and services for older adults. The views of stakeholders on the acceptability of technological solutions for frailty screening and management have not been explored. Methods Focus groups were used to gather data from healthy and frail/pre-frail older adults, health and social care providers, and caregivers in three European countries – Italy, Poland and UK. Data were analysed using framework analysis in terms of facilitators or determinants of older adults’ adoption of technology. Results Our findings clustered around the perceived value; usability, affordability and accessibility; and emotional benefits of frailty screening and management technology to stakeholders. We also noted issues relating to social support, previous experience of technology and confidence of stakeholders. Conclusions Professionals and caregivers understand the benefits of technology to facilitate frailty care pathways but these views are tempered by concerns around social isolation. Frail older adults raised legitimate concerns about the accessibility and usability of technology, specifically around the potential for their personal information to be compromised. Solutions must be developed within a framework that addresses social contexts and avoids stigma around frailty and ageing.
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Affiliation(s)
- Holly Gwyther
- The Centre for Ageing Research, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33B, 7522, Enschede, AH, Netherlands
| | - Rachel L Shaw
- Research Centre for Healthy Ageing, School of Life and Health Sciences, Aston University, B4 7ET, Birmingham, UK
| | - Barbara D'Avanzo
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Bujnowska-Fedak
- Family Medicine Department, Wroclaw Medical University, Syrokomli 1, 51-141, Wroclaw, Poland
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Syrokomli 1, 51-141, Wroclaw, Poland.,Opole Medical School, ul. Katowicka 68, 45-060, Opole, Poland
| | - Katarzyna Szwamel
- Family Medicine Department, Wroclaw Medical University, Syrokomli 1, 51-141, Wroclaw, Poland.,Opole Medical School, ul. Katowicka 68, 45-060, Opole, Poland
| | - Jan-Willem Van't Klooster
- BMS Lab, Faculty of behavioural, management and social sciences, University of Twente, Drienerlolaan 5, 7522, Enschede, NB, Netherlands
| | - Carol Holland
- The Centre for Ageing Research, Lancaster University, Lancaster, LA1 4YG, UK
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Jansen-Kosterink S, van Velsen L, Frazer S, Dekker-van Weering M, O'Caoimh R, Vollenbroek-Hutten M. Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway: a methodological guide and results of a large-scale deployment in the Netherlands. BMC Public Health 2019; 19:504. [PMID: 31053090 PMCID: PMC6500037 DOI: 10.1186/s12889-019-6876-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. Methods The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. Results In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. Conclusion Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.
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Affiliation(s)
- Stephanie Jansen-Kosterink
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands. .,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Sanne Frazer
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Marit Dekker-van Weering
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, Cork City, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland
| | - Miriam Vollenbroek-Hutten
- University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.,ZiekenhuisGroep Twente (ZGT), scientific office ZGT academie, Almelo, the Netherlands
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