Design Features of Embodied Conversational Agents in eHealth: a Literature Review
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Embodied conversational agents (ECAs) are gaining interest to elicit user engagement and stimulate actual use of eHealth applications. In this literature review, we identify the researched design features for ECAs in eHealth, the outcome variables that were used to measure the effect of these design features and what the found effects for each variable were. Searches were performed in Scopus, ACM Digital Library, PsychINFO, Pubmed and IEEE Xplore Digital Library, resulting in 1284 identified articles of which 33 articles were included. The agents speech and/or textual output and its facial and gaze expressions were the most common design features. Little research was performed on the agent's looks. The measured effect of these design features was often on the perception of the agent's and user’s characteristics, relation with the agent, system usage, intention to use, usability and behaviour change. Results show that emotion and relational behaviour seem to positively affect the perception of the agents characteristics and that relational behaviour also seems to positively affect the relation with the agent, usability and intention to use. However, these design features do not necessarily lead to behaviour change. This review showed that consensus on design features of ECAs in eHealth is far from established. Follow-up research should include more research on the effects of all design features, especially research on the effects in a long-term, daily life setting, and replication of studies on the effects of design features performed in other contexts than eHealth.
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Little is known about how ECAs should be designed and how design affects impressions, and no design guidelines exist.
“little is known about how these agents should be designed and how the design affects our impressions of the agents, and no design guidelines exist [15].”
From Embodied Conversational Agent Appearance for Health Assessment of Older Adults: Explorative Study (2020) · cites this paper as [15]
This study mapped how the readiness level of ECA-based interventions grew across the years, shifting from a display on standard television sets and computer screens to mobile stand-alone solutions such as Anne.
“From a technical point of view, this study mapped how the readiness level of ECA-based interventions grew across the years, shifting from a display on standard television sets [7] and computer screens [8-12] to mobile stand-alone solutions such as in the specific case of Anne.”
This framework of 4 weeks of interaction between 20 seniors with dementia and the agent Anne in a home setting is rare in ECA research, which mainly comprises studies on short-term interaction in a controlled environment and smaller sample size enrollment.
“This framework is rare in ECA research, which mainly comprises studies on short-term interaction in a controlled environment [13] and smaller sample size enrollment [7-12].”
The MAX conversational agent is the first (to the best of our knowledge) conversational agent that takes over the role of a scalable social actor framed as a scalable assistant of a health care professional that mediates communication among various relevant stakeholders in the context of chronic disease management.
“the current conversational agent is the first (to the best of our knowledge) that takes over the role of a scalable social actor framed as a scalable assistant of a health care professional that mediates communication among various relevant stakeholders in the context of chronic disease management.”
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“Although ECAs have the potential to be used as eHealth apps such as digital frailty assessments, little is known about how these agents should be designed and how the design affects our impressions of the agents, and no design guidelines exist [15].”
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The Impact of Virtual Humans on Psychosomatic Medicine
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The Co-Design of an Embodied Conversational Agent to Help Stroke Survivors Manage Their Recovery
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Understanding the Application of AI-enabled Chatbots in Luxury Fashion Retailing
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Investigating the use of speech-based conversational agents for life coaching
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Designing Virtual Coaching Solutions
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Reason Explanation for Encouraging Behaviour Change Intention
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“[47] concluded that not all of the investigated design features have proven their effectiveness in achieving health-related goals and that agent relational/empathic behaviour is the most promising feature towards improving the useragent relationship.”
BackgroundInfluentialSocialni odnosi, animizem, antropomorfizem in interakcija z UI
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Evaluating face gender cues in virtual humans within and beyond the gender binary
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Development of a Virtual Human for Supporting Tobacco Cessation During the COVID-19 Pandemic
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Look who's talking: appearance of embodied conversational agents in eHealth
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- Authors
- ter Stal, S., Kramer, L. L., Tabak, M., op den Akker, H., & Hermens, H.
- Affiliations
- Wageningen University & Research (NL)
- Roessingh Research and Development (NL)
- Venue
- International Journal of Human-Computer Studies
- Publisher
- Elsevier BV
- Published
- 2020-06
- Volume
- 138
- Pages
- 102409
- ISSN
- 1071-5819 (ISSN-L)
- OpenAlex
- W3005092074
- Cited by
- 188
- References
- 76
- Citations by year
- 2026: 22 · 2025: 22 · 2024: 24 · 2023: 39 · 2022: 41 · 2021: 33 · 2020: 7
- FWCI
- 32.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Human-Computer Studies (publishedVersion, cc-by-nc-nd)
- University of Twente Research Information (publishedVersion, cc-by-nc-nd)
- Socio-Environmental Systems Modeling (acceptedVersion, cc-by-nc-nd)
- University of Twente Research Information (submittedVersion, cc-by-nc-nd)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc-nd)
- Funders
- Horizon 2020
- Topics
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Physical Sciences › Computer Science › Human-Computer Interaction › Innovative Human-Technology Interaction
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- embodied conversational agents, e-health, design features, speech output, facial expressions, agent appearance, intention to use, usability, behavior change, user engagement
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