Usability of conversational agents by patients with inadequate health literacy: evidence from two clinical trials
Open accessAbstract
Embodied Conversational Agents (ECA) are computer-animated characters that simulate face-to-face conversation with patients. These agents can be programmed with best practices in human-human health communication and used for automated health education and behavior change counseling interventions. Evidence is presented from two ongoing clinical trials demonstrating that patients at different levels of health literacy find these agents acceptable and easy to use for automated health communication interventions. Innovative computer interface systems can be used to ensure that inadequate health literacy not serve as a barrier to interventions using health information technology.
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Overall, ECAs have been received positively by patients and increased adherence to treatment regimens.
“Overall, these have been received positively by patients and increased adherence to treatment regimens.11,20,65,66”
From A chatbot for hypertension self-management support: user-centered design, development, and usability testing (2023) · cites this paper as [20]
The Discussion reports that patients generally found the ECAs acceptable and usable, supporting positive reception. The ECA-Based Health Intervention Clinical Trials section says the authors assessed satisfaction and usability while remaining blinded to health outcomes; it does not establish that ECAs increased adherence to treatment regimens. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPrior studies of ECAs have simulated a health provider for health coaching and reviewing hospital discharge materials.
“Prior studies of ECAs have simulated a health provider for health coaching and reviewing hospital discharge materials.11,20,65,66”
From A chatbot for hypertension self-management support: user-centered design, development, and usability testing (2023) · cites this paper as [20]
Prior pilots have demonstrated acceptability of ECAs in both inpatient and outpatient settings.
“Prior pilots have demonstrated acceptability of ECAs in both inpatient [17–19] and outpatient settings [20, 21].”
From Engaging women with an embodied conversational agent to deliver mindfulness and lifestyle recommendations: A feasibility randomized control trial (2017) · cites this paper as [17]
Virtual patient advocates are well suited to deliver preconception care because they can reach many patients, reduce clinician time demands, control costs, and achieve high acceptability through culturally appropriate and low-health-literacy-appropriate content.
“VPAs are ideal for delivering PCC because they can potentially reach a large number of patients, alleviate clinician time restraints, and control costs while simultaneously having high patient acceptability through culturally appropriate content17 and information appropriate to those with low health literacy.18, 19”
From Reaching Women through Health Information Technology: The Gabby Preconception Care System (2013) · cites this paper as [19]
Conversational agents are a promising tool for the advancement of patient-centered care and can support users' involvement in the management of their own health.
“Due to this accessibility, conversational agents are also a promising tool for the advancement of patient-centered care and can support users’ involvement in the management of their own health [17,18].”
From The Effectiveness of Artificial Intelligence Conversational Agents in Health Care: Systematic Review (2020) · cites this paper as [17]
Conversational agents can support populations with limited access to health care or poor health literacy.
“With phone, mobile, and online platforms being widely accessible, conversational agents can support populations with limited access to health care or poor health literacy [16,17].”
From The Effectiveness of Artificial Intelligence Conversational Agents in Health Care: Systematic Review (2020) · cites this paper as [17]
Conversational agents are helping to provide patient-centered care by increasing patients' involvement in their health care and decision making.
“Finally, these agents are helping to provide patient-centered care by increasing the patients’ involvement in their health care and decision making [2,17,18].”
From Effectiveness of Conversational Agents (Virtual Assistants) in Health Care: Protocol for a Systematic Review (2020) · cites this paper as [17]
The widespread availability of digital platforms through which conversational agents operate enables populations with limited health provision or health literacy to access these services.
“The widespread availability of the digital platforms through which these conversational agents operate enables populations with limited health provision or health literacy to access these services”
From Effectiveness of Conversational Agents (Virtual Assistants) in Health Care: Protocol for a Systematic Review (2020) · cites this paper as [17]
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References 35 · Cited by 249
Research works printed but not linked: 3
- [13]13. Clinite, J., & Kabat, H. (1976). Improving patient compliance. Journal of the American Pharm Association, 16, 74-76.
- [23]23. Madden, E. (1973). Evaluation of outpatient pharmacy patient counseling. Journal of the American Pharm Association, 13, 437-443.
- [33]33. Yin, L., Bickmore, T., Byron, D., & Cortes, D. (2010). Cultural and linguistic adaptation of relational agents for health counseling. In Workshop on interactive systems in healthcare. Atlanta, GA.
- Authors
- Bickmore, T. W., Pfeifer, L. M., Byron, D., Forsythe, S., Henault, L. E., Jack, B. W., Silliman, R., & Paasche-Orlow, M. K.
- Affiliations
- Northeastern University (US)
- Boston University (US)
- Corresponding author
- Bickmore, Timothy W.
- Venue
- Journal of Health Communication
- Publisher
- Informa UK Limited
- Published
- 2010-08-31
- Volume
- 15
- Issue
- sup2
- Pages
- 197-210
- ISSN
- 1081-0730 (ISSN-L)
- 1087-0415
- OpenAlex
- W2037859676
- Semantic Scholar
- 7720eec07059f2d604ed867934b679addb7f3da6
- Cited by
- 249
- References
- 35
- Citations by year
- 2026: 20 · 2025: 22 · 2024: 18 · 2023: 19 · 2022: 15 · 2021: 20 · 2020: 32 · 2019: 19 · 2018: 12 · 2017: 21 · 2016: 7 · 2015: 13 · 2014: 15 · 2013: 9 · 2012: 5
- FWCI
- 6.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Health Communication (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (R01AG028668)
- Topics
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- embodied conversational agents, health literacy, usability, health education, behavior change counseling, patient acceptability, health information technology
- MeSH terms
- Adult, Aftercare, Aged, Aged, 80 and over, Automation, Computer Simulation, Female, Health Promotion, Humans, Male, Middle Aged, Patient Education as Topic, User-Computer Interface, Randomized Controlled Trials as Topic, Walking, Patient Satisfaction, Young Adult, Health Literacy
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