Conversational Agents in Health Care: Expert Interviews to Inform the Definition, Classification, and Conceptual Framework

BACKGROUND

Conversational agents (CAs), or chatbots, are computer programs that simulate conversations with humans. The use of CAs in health care settings is recent and rapidly increasing, which often translates to poor reporting of the CA development and evaluation processes and unreliable research findings. We developed and published a conceptual framework, designing, developing, evaluating, and implementing a smartphone-delivered, rule-based conversational agent (DISCOVER), consisting of 3 iterative stages of CA design, development, and evaluation and implementation, complemented by 2 cross-cutting themes (user-centered design and data privacy and security).

OBJECTIVE

This study aims to perform in-depth, semistructured interviews with multidisciplinary experts in health care CAs to share their views on the definition and classification of health care CAs and evaluate and validate the DISCOVER conceptual framework.

METHODS

We conducted one-on-one semistructured interviews via Zoom (Zoom Video Communications) with 12 multidisciplinary CA experts using an interview guide based on our framework. The interviews were audio recorded, transcribed by the research team, and analyzed using thematic analysis.

RESULTS

Following participants' input, we defined CAs as digital interfaces that use natural language to engage in a synchronous dialogue using ≥1 communication modality, such as text, voice, images, or video. CAs were classified by 13 categories: response generation method, input and output modalities, CA purpose, deployment platform, CA development modality, appearance, length of interaction, type of CA-user interaction, dialogue initiation, communication style, CA personality, human support, and type of health care intervention. Experts considered that the conceptual framework could be adapted for artificial intelligence-based CAs. However, despite recent advances in artificial intelligence, including large language models, the technology is not able to ensure safety and reliability in health care settings. Finally, aligned with participants' feedback, we present an updated iteration of the conceptual framework for health care conversational agents (CHAT) with key considerations for CA design, development, and evaluation and implementation, complemented by 3 cross-cutting themes: ethics, user involvement, and data privacy and security.

CONCLUSIONS

We present an expanded, validated CHAT and aim at guiding researchers from a variety of backgrounds and with different levels of expertise in the design, development, and evaluation and implementation of rule-based CAs in health care settings.

Towards a Recommendation for Good Health Data Modeling (GHDM) - Results of Expert Interviews

Appropriate data models are essential for the systematic collection, aggregation, and integration of health data and for subsequent analysis. However, recommendations for modeling health data are often not publicly available within specific projects. Therefore, the project Zukunftslabor Gesundheit investigates recommendations for modeling. Expert interviews with five experts were conducted and analyzed using qualitative content analysis. Based on the condensed categories "governance", "modeling" and "standards", the project team generated eight hypotheses for recommendations on health data modeling. In addition, relevant framework conditions such as different roles, international cooperation, education/training and political influence were identified. Although emerging from interviewing a small convenience sample of experts, the results help to plan more extensive data collections and to create recommendations for health data modeling.

Expert Perspectives on the Effectiveness of Psychotherapy

The effectiveness of psychotherapeutic care, as well as the implementation of adequate improvements, are in question. A qualitative interview study was carried out in a cyclical research design with a comparative analysis on the basis of thematic coding using Grounded Theory Methodology. An overview of the design, sampling procedure, and data analysis is given. A variety of critical perspectives emerged concerning the state of psychotherapeutic care in Austria. Two perspectives are presented in this paper as interim results: a health care administration perspective states a general lack of knowledge and a possible unmet need, problematizes the underutilized benefit of psychotherapists and describes a shift in regard to the issue of effectiveness of care to the topic of access to psychotherapeutic care and to a problem with the care and work ethics of professionals. In this perspective, one solution may be to implement intermediary organizations, clearinghouses with multi-professional teams, comprehensive documentation and an indication-oriented approach. The health insurance perspective also claims the organization-specific action problem and the lack of rules for clearing in such intermediary organizations, as well as the relevance of regulated, limited access to psychotherapy.

Which Factors Influence the Immensely Fluctuating CRT Implantation Rates in Europe? A Mixed Methods Approach Using Qualitative Content Analysis Based on Expert Interviews

(1) Background: Cardiac resynchronisation therapy (CRT) is nowadays an indispensable treatment option for heart failure. Although the indication is subject to clear cross-national guidelines by the European Society of Cardiology (ESC), there is immense variation in the number of implantations per 100,000 inhabitants in Europe, especially in German-speaking countries (Germany, Austria and Switzerland). The aim of the present study was to identify possible factors for these differences using a qualitative research approach. (2) Methods: Semi-standardized interviews were conducted with 11 experts in the field of CRT therapy (3 experts from Germany, 4 from Austria and 4 from Switzerland) using a pre-prepared interview template and analysed according to Mayring's qualitative content analysis. (3) Results: The main factors identified were the costs of purchasing the devices and the financing systems of the respective healthcare systems, although cost pressure still seems to play a subordinate role in the German-speaking countries. Moreover, "lack of implementation of ESC guidelines", "insufficient training" and "lack of medical infrastructure" could be excluded as potential reasons. (4) Conclusions: Economic factors, but not a lack of adherence to ESC guidelines, seem to have a major influence on the fluctuating implantation figures in German-speaking countries, according to the unanimous assessment of renowned experts.

Developing eminence in STEMM: An interview study with talent development and STEMM experts

In the present day, we need outstanding scientists, engineers, mathematicians, and medical science researchers more than ever to solve the world's most pressing issues, such as climate change, water contamination, and cyber security. Naturally, we ask the question: What does it take to develop eminence in science, technology, engineering, mathematics, and medical science (STEMM)? To answer this question, we interviewed two relevant groups of experts: 14 talent development researchers and 14 STEMM experts. The interview questions were developed based on the theoretical framework of the Actiotope Model of Giftedness and the related educational and learning capital approach that differentiates five types of exogenous resources (educational capital) and five types of endogenous resources (learning capital) that feed into talent development toward eminence. The results show that all types of capital were regarded as important by the experts for developing eminence in STEMM. However, there were also differences. We describe the educational and learning capital that talent development researchers and STEMM experts considered to be important for talent development in STEMM, as well as the similarities and differences between the two groups.

Techno-Economic Prospects and Desirability of 3D Food Printing: Perspectives of Industrial Experts, Researchers and Consumers

3D food printing is an emerging food technology innovation that enables the personalization and on-demand production of edible products. While its academic and industrial relevance has increased over the past decade, the functional value of the technology remains largely unrealized on a commercial scale. This study aimed at updating the business outlook of 3D food printing so as to help entrepreneurs and researchers in the field to channel their research and development (R&D) activities. A three-phase mixed methods approach was utilized to gain perspectives of industrial experts, researchers, and potential consumers. Data were collected from two sets of interviews with experts, a survey with experts, and consumer focus group discussions. The results gave insights into key attributes and use cases for a 3D food printer system, including the techno-economic feasibility and consumer desirability of identified use cases. A business modelling workshop was then organized to translate these results into three refined value propositions for 3D food printing. Both the experts and consumers found personalized nutrition and convenience to be the most desirable aspects of 3D food printing. Accordingly, business models related to 3D printed snacks/meals in semi-public spaces such as fitness centers and hospitals were found to offer the highest business potential. While the technology might be mature enough at component level, the successful realization of such high-reward models however would require risk-taking during the developmental phase.

Changed priorities ahead: Journalists' shifting role perceptions when covering public health crises

Journalistic role perceptions have been extensively studied in general contexts, but little is known as to how roles - or role prioritization - may shift across contexts, and professional characteristics. The aim of this study was gaining an understanding of journalists' changing role perceptions in health crisis coverage, and moreover to examine potential differences between general and specialist reporters. We conducted 22 in-depth interviews with reporters with experience in health crisis reporting in Germany and Finland. Findings suggest that journalists' roles shift when covering health crises (versus non-crises), towards a role as public mobilizers, towards classifying risks and from a watchdog to a more co-operative role. Furthermore, professional characteristics matter in journalists' understanding and performance of their roles. Specialist reporters appear better equipped to deal with the challenges of health crisis coverage, such as balancing remaining critical with co-operation with authorities in their efforts to contain crises. Specialist reporters are also less likely to get swayed by the panic often accompanying health crises than general reporters are.

Beyond Cognition: Experts' Views on Affective-Motivational Research Dispositions in the Social Sciences

Research competence (RC) as a key ability of students in the social sciences has thus far been conceptualized as consisting primarily of cognitive dispositions. However, owing to its highly complex and demanding nature, competence in conducting research might require additional affective and motivational dispositions. To address this deficiency in the literature, first, we conducted a qualitative interview study with academic experts (N = 16) in which we asked them to identify challenging research situations and the affective-motivational research dispositions needed to cope with them. We employed a subsequent online rating (N = 27) to evaluate the situations and dispositions that had been identified. The resulting affective-motivational facet of RC encompasses six challenging situations that are often encountered and nine dispositions that are necessary to successfully conduct research in the social sciences and may be used to both inform and evaluate research-based learning. The interview-based approach may serve as an exemplary procedure to postulate affective-motivational facets of competence models.

[The Problems of Statistical Registration of Mortality Because of External Causes in Russia]

In Russia, the level of mortality of class of external causes in general and of particular cause within this class two-fold exceeds similar levels of these indices in the developed countries. The actual publications analyzing medical death certificates emphasize underestimation of levels of mortality because of such external causes as murders, suicides, alcohol intoxications, etc. and their transfer to latent form. In this connection, the topic of external causes was chosen to be a purpose of interviewing leading specialists in the field of demography, statistics and medicine. On the basis of analysis of opinions of experts, the issues of quantitative and qualitative statistical registrations of mortality because of external causes were considered. According opinion of experts, the external causes' statistic is to be published in concordance with the ICD-10. On the basis of the short list of ICD-10 the total scale of losses because of mortality of class of external causes and their kinds are clearly demonstrated. However, an in-depth analysis of mortality the detailed elaboration of the short list of ICD-10 is inadequate. The experts also considered both the causes of increasing of such a set of external causes as injuries with uncertain intentions and the means of decreasing level of mortality because of these causes including the main ones - changes of requirements to fill and procedure to issue death certificates. The experts considered too the legislative consolidation of regulation that inquest is to be initiated on the basis of application, report of offense but not the procedural standard concerning institution of prosecution and cardinal amelioration of the system of forensic expertise.

[Barriers to treatment-seeking among German veterans: expert interviews]

BACKGROUND

The number of service members of the German armed forces suffering from deployment-related mental health problems is increasing. However, less than 50 % seek professional help, and there is little knowledge about the barriers to treatment-seeking.

METHODS

The article presents data gathered by the Delphi technique combined with focus groups from 55 health service experts regarding the evaluated barriers to treatment-seeking among German veterans.

FINDINGS

According to the interviewed experts, major contextual barriers to treatment-seeking include: 1) intimidating processes and structures, 2) actual stigmatization and discrimination, and 3) health service deficits. Major individual barriers to treatment were: 4) health beliefs, self-perception and fear of stigmatization, and 5) avoidance behavior related to psychopathology. In addition, there is another both contextual and individual barrier, i.e., 6) information deficits.

INTERPRETATION

Individual internal factors like the soldiers' self-perception and their fear of being stigmatized were considered important barriers to treatment-seeking. The experts' opinion about avoidance behavior related to psychopathology and deficits in health services and information coincides with international findings. Compared to research in other countries, actual stigmatization and discrimination were regarded to be an important barrier in itself. According to our findings daunting/intimidating processes and structures like time-consuming and complex expert medical reports rather seem to be a German phenomenon.