The DOI matches its Crossref record; 102 of the 102 references it cites were found in a registry or an index; 1 of the 97 sources its claims cite were checked for support.
Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study
Open accessPublished version of a preprint
Abstract
Background: Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration. Objective: With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent–delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent–patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings. Methods: MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent–patient working alliance; (2) to offer hybrid (human- and conversational agent–supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX. Results: Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made. Conclusions: This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a “team player” role but also show potential to improve health-relevant outcomes in chronic disease management.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In a multisite single-arm feasibility study, MAX, a conversational agent designed as a mediating social actor for pediatric asthma, was feasible and positively evaluated across patients, family members, and health care professionals. It showed high reach, strong patient-agent working alliance, 75.5% completion, improved asthma knowledge, and scalable delivery with most conversational turns handled by the agent.
Key findings
- Reach was 49.5% (49/99 recruited and eligible patient-family member teams started interacting with MAX); intervention completion was 75.5% (37/49).
- Patient-MAX working alliance was high across coaching sessions 2, 8, and 14 (means 6.34, 6.14, and 6.34, respectively), and acceptance ratings were above the neutral scale value of 4 (perceived usefulness 6.42, ease of use 6.75, enjoyment 6.47, control 5.53, intention to continue 5.58).
- Asthma knowledge increased significantly from pretest to posttest (7.73 to 8.79 with baseline observation carried forward, n=48, P<.001, d=0.91; 9.43 in complete cases, n=37, P<.001, d=1.19).
- Family members supported patients in 269/275 (97.8%) coaching sessions; 99.5% (15,078/15,152) of conversational turns were between patients and MAX versus 0.5% (74/15,152) between patients and health care professionals. Health care professionals took an average of 221 seconds to assess inhalation videos and 2.34 days to provide feedback.
Methods
- Single-arm feasibility study conducted in two home care settings and four secondary care settings in the German-speaking part of Switzerland; recruitment occurred January-April 2019.
- Participants were 10- to 15-year-old German-speaking patients with asthma who had smartphone access and a German-speaking family member able to receive SMS messages and support the patient every second intervention day; 99 patients were approached and 49 started interacting with MAX.
- Outcomes included reach, patient-conversational agent working alliance, acceptance, intervention completion, cognitive and behavioral skills, and human effort/responsiveness; analyses included descriptive statistics, paired-sample t tests for asthma knowledge, and qualitative feedback.
Limitations
- The paper states that this was a feasibility study with a limited sample, so results are not representative and must be interpreted with caution; only health care professionals from four hospitals and two cantonal patient organizations participated, leaving unclear whether MAX would work similarly with general practitioners.
- The paper states that qualitative open coding was performed by one author, social support was self-reported and incentivized and thus likely overestimated, and the MAX interface was not integrated into hospital or patient-organization information systems, likely overestimating efforts; only costs and efforts were reported, so no cost-effectiveness implications can be drawn.
- Evident from the text: the single-arm design without a control group limits causal conclusions about intervention effects, and the small, exploratory sample constrains generalizability.
Model-written summary. Check it against the paper before relying on it.
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Figures
![Figure 1 Conceptual model of the intervention. Intervention components are represented by black boxes; behavioral change technique numbers [65] are listed in brackets for each intervention component. CA: conversational agent.](/paper-figures/8de3402f216d4aa4bc959e6744a3688e/conversational-agents-as-mediating-social-actors-in-chronic-disease-management-figure-1.jpg)
Verification
Claims the paper makes
37 Not checked yet · 34 Own result · 20 Own interpretation · 7 Own method · 3 No basis given · 1 Partly supported · accuracy not yet measured
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In the paper
“Previous studies in other health domains have demonstrated promising results in using conversational agents to improve outcomes, such as promoting physical activity for childhood obesity [104,114].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Comparison With Prior Work
What the sources say
- Not checked yetcites [104] source
- Partly supportedcites [114] sourceExperimental — accuracy not yet measured
The Methods section describes Ally as a chatbot designed to promote physical activity and reports promising outcomes from earlier MobileCoach interventions for adolescent drinking and smoking-cessation engagement. It does not report that Ally improved physical activity, and the trial enrolled insurance customers with a mean age of 41.73 years, not children with obesity (Abstract, Results). (LLM, conf=0.88)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“an intervention completion rate of 75.5%”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Family members supported the patients in 269 out of 275 (97.8%) coaching sessions.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it took health care professionals less than 4 minutes to assess the inhalation technique”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“a strong patient-conversational agent working alliance”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“high acceptance by all relevant stakeholders”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated)”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The session alliance inventory indicated high working alliance ratings between the young patients and the MAX conversational agent from the very beginning of the intervention until the end (Table 1).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Session Alliance Inventory
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Out of 275 coaching sessions, in which a family member was asked to support the young patients, patients indicated 269 times (97.8%) that they were supported by a family member.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Technology Acceptance
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Paired-sample t tests revealed a significant increase in scores and large effects with two approaches: a complete case analysis (n=37, t36=–3.68, P<.001, d=1.19) and with the baseline observation carried forward (n=48, t47=–3.54, P<.001, d=0.91).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Asthma Knowledge
plaindirectn = 37 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Availability of a smartphone was the major reason for nonparticipation (n=14, 14%), and the most frequent dropouts happened during onboarding (n=3) and Coaching Session 6 (n=3).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Participant Characteristics
plainn = 3- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, health care professionals identified 0.9 inhalation mistakes in each video clip (N=42).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Intervention Completion Rate
plainn = 42- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“between 0.1 and 2.5 SMS reminders were sent out on average per patient by the MAX conversational agent (Table 1)”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Human Effort and Responsiveness of Health Care Professionals
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Availability of a smartphone was the major reason for nonparticipation (n=14, 14%), and the most frequent dropouts happened during onboarding (n=3) and Coaching Session 6 (n=3).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Participant Characteristics
plaindirectn = 14- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Paired-sample t tests revealed a significant increase in scores and large effects with two approaches: a complete case analysis (n=37, t36=–3.68, P<.001, d=1.19) and with the baseline observation carried forward (n=48, t47=–3.54, P<.001, d=0.91).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Asthma Knowledge
plaindirectn = 48 ·- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“patients received feedback on their submitted video clips after an average of approximately 2.4 days (Table 2).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Human Effort and Responsiveness of Health Care Professionals
plain- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All of these clips had sufficient technical quality for evaluation.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Intervention Completion Rate
plainn = 42- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the average time of the app onboarding process (excluding study-specific discussions) was approximately 15 minutes.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Human Effort and Responsiveness of Health Care Professionals
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Furthermore, since there was a clear difference in the assessment time of the inhalation video clips between the primary and secondary care settings, a dedicated and specialized expert may be considered for this task.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The qualitative feedback suggested several valued and important features, as well as challenges and potential improvements of the intervention.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Even though the text-based conversational agent was perceived as positive and engaging, participants indicated that the conversational agent had too many predefined answer options.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“In addition, patients require specialized cognitive and behavioral skills to deal with their condition [4,5].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Digital health interventions are emerging tools for the management of chronic diseases, as they can educate and engage patients through a direct channel that supports communication with physicians and health care professionals [7,8]”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a “team player” role”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Conclusions
plain- Asserted: passes — The authors put it forward as true.
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- Rests on an assumption: Conversational agents can act as mediating social actors, taking over a significant amount of intervention delivery in a scalable manner and coordinating communication among health care professionals, family members, and patients if required.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“but also show potential to improve health-relevant outcomes in chronic disease management.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Conversational agents can act as mediating social actors, taking over a significant amount of intervention delivery in a scalable manner and coordinating communication among health care professionals, family members, and patients if required.
None of the sources cited for this claim have been checked yet.
In the paper
“and enable the scale up of personalized and behavioral interventions at low cost [1,9].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
plaindirect- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
What the sources say
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“This is also the first assessment of this type of mediating conversational agent outside of a lab setting, as many other conversational agents have been assessed [96], but rather in a realistic longitudinal intervention field study in a complex sociotechnical system with various stakeholders.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
What the sources say
- Not checked yetcites [96] source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Moreover, there is evidence that shared decision making and collaboration among patients, parents, and health care professionals are key success factors in guided asthma self-management programs with improved adherence and health outcomes [55].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
- Not checked yetcites [55] source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“With the MAX conversational agent, we were also able to show how to extend the reach of health care professionals into the everyday lives of patients in an efficient way without compromising the quality of care and working alliance.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
plaindirect- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“However, young patients still face problems related to both cognitive and behavioral skills that hinder their ability to effectively administer asthma medications [30-35].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, the MAX conversational agent was able to motivate family members to support the young patients most of the time when asked (97.8%).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
plaindirect- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Additionally, due to absent or insufficient motivation strategies such as interactivity, proper incentives and rewards [48], and experiential value [49-51], the effects of the previously reported digital interventions in asthma, such as the health condition of the young patients, are prone to be negatively affected by the temporal decline in the patients’ engagement and motivation [10,52-54].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In terms of human effort and responsiveness of health care professionals, it can be concluded that the MAX intervention is scalable since most of the conversational turns (99.5%) involved the patients and the MAX conversational agent.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We have shown that conversational agents framed as digital assistants of health care professionals have the potential to improve cognitive and behavioral skills in chronic disease management, with asthma in children as one specific example.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The observed improvements in cognitive and behavioral skills are attributable to the MAX intervention rather than other factors.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A unique advantage of MAX is its use of a three-component intervention that involves health care professionals, the digital assistant MAX, and family members to support young patients as they work on specific tasks to expand asthma knowledge and improve behavioral skills.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Comparison With Prior Work
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“to identify a relevant amount of usability problems, at least 20 participants were required according to heuristics in usability engineering [90].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
What the sources say
- Not checked yetcites [90] NielsenJLandauerTKModel of the finding of usability problems1993ACM Conference on Human Factors in Computing Systems (CHI)1993Netherlands206213
plainn = 20- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The design of MAX was driven by an interdisciplinary effort that resulted in a conceptual model with intervention components informed by human behavior and experiential learning theories [61,65,66], findings from technology acceptance research [49,51,58,102], and prior experiences of the authors with conversational agents that support health care professionals and young adolescent patients [67,68]”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
What the sources say
- Not checked yetcites [61] source
- Not checked yetcites [65] source
- Not checked yetcites [66] Kolb, DA, 1984, Experience as the source of learning and development
- Not checked yetcites [49] source
- Not checked yetcites [51] source
- Not checked yetcites [58] source
- Not checked yetcites [102] source
- Not checked yetcites [67] source
- Not checked yetcites [68] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“By applying a scalable conversational agent for asthma specifically, the MAX intervention can provide greater health care professional interaction at reduced cost, which has been a key concern in past asthma interventions [113].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Comparison With Prior Work
What the sources say
- Not checked yetcites [113] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Further, only health care professionals from four hospitals (eg, pediatric pneumologists) and two cantonal patient organizations of the Swiss Lung Association participated in this study.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
plainn = 2- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Another limitation of this study pertains to the inductive open coding of the interviews that was performed by one author only (SH), resulting in a certain bias of the qualitative results.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A systematic review of 15 different digital interventions for pediatric asthma management showed that 87% of the interventions improved medication and behavioral adherence, and 53% demonstrated improved health outcomes [113].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Comparison With Prior Work
What the sources say
- Not checked yetcites [113] source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Although these mobile health apps offer a range of features (eg, automated personalized texts, interactive websites, and online modules) to inform patients about asthma, they have not included scalable text-based health care conversational agents to support communication with health care professionals.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Comparison With Prior Work
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, since the social support assessment was self-reported by the young patients and linked to additional points for the MAX intervention (to increase the chance to be among the winners), it can be assumed that the supportive involvement of family members was overestimated.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“A systematic review of 15 different digital interventions for pediatric asthma management showed that 87% of the interventions improved medication and behavioral adherence, and 53% demonstrated improved health outcomes [113].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Comparison With Prior Work
What the sources say
- Not checked yetcites [113] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it can be concluded that the MAX intervention is scalable since most of the conversational turns (99.5%) involved the patients and the MAX conversational agent.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The quote only partly states this claim. 2
- Probably not a substantial claim. 32
- It may state two separate claims as one. 29
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“MAX led to improved cognitive and behavioral skills”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and 3 days to deliver related feedback to the patients”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“MAX led to improved cognitive and behavioral skills”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Abstract > Results
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Participants who finished the intervention (n=37) did so on average within 3 weeks, which was within the incentivized duration of 4 weeks.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Participant Characteristics
plainn = 37- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All mean values lie clearly above the neutral scale value of 4, indicating positive evaluations of the mobile app.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Technology Acceptance
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The single-item measures used to assess technology acceptance are sufficient to validly measure the constructs.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For two video clips, three serious inhalation mistakes were identified, eliciting a feedback to resend a corrected video clip. After resubmission, no severe inhalation mistakes could be identified in the second video clip.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Intervention Completion Rate
plaindirectn = 42- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“99.5% (15,078/15,152) took place between patients and the MAX conversational agent, and only 0.5% (74/15,152) occurred between patients and health care professionals (Table 1).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Human Effort and Responsiveness of Health Care Professionals
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The intervention completion rate was 75.5%, as 37 out the 49 patients finished the intervention.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Intervention Completion Rate
plainn = 49- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, patients learned new aspects about asthma management and enjoyed the coaching sessions.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Technology Acceptance
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The single-item measures used to assess technology acceptance are sufficient to validly measure the constructs.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, it took them less than 4 minutes to assess the inhalation technique and 3 days to deliver that feedback to the patients.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, 42 inhalation video clips were recorded and submitted to the health care professionals (Table 2).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Intervention Completion Rate
plainn = 42- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it took health care professionals an average of 221 seconds to assess the videos clips, with a clear difference observed between health care settings (average of 410 seconds in the primary care setting and 127 seconds in the secondary care setting; see Table 2).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Human Effort and Responsiveness of Health Care Professionals
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For the gender-specific choices of the MAX conversational agent, all participants chose the character corresponding to their own indicated gender.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Technology Acceptance
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reach was 49.5% with 49 out of 99 approached patients downloading the app and starting to interact with the MAX conversational agent.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Participant Characteristics
plainn = 99- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“For each patient, this intervention involved an average of 20 minutes of human effort, 10 automated SMS text messages, including three reminders, and additional costs for gift vouchers, including lottery winnings.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the text-based conversational agent was perceived as positive and engaging”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“therapeutic alliance [16,17]”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Chronic conditions present a significant risk to the global population, and cause substantial financial and health-related burdens, resulting in low quality of life of those affected [1].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
- Not checked yetcites [1] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Successful disease management often requires a trustful collaboration among health care professionals, patients, and their families [3].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
- Not checked yetcites [3] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Indeed, several recent studies have provided evidence supporting the patient benefits of such digital interventions, particularly in children and adolescents [10-14].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“conversational agents (ie, computer programs that imitate interaction with human beings) have shown promising results with respect to patient satisfaction [15]”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
- Not checked yetcites [15] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Asthma is associated with high financial and health costs, with total annual asthma costs in the United States estimated at US $56 billion in 2011 [23].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
- Not checked yetcites [23] source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The intervention was developed with the open-source software platform MobileCoach [67,83,84], which has already been used successfully for various clinical and public health interventions [17,68,77-79,85,86]”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Technical Implementation
What the sources say
- Not checked yetcites [67] source
- Not checked yetcites [83] source
- Not checked yetcites [84] MobileCoach2021-02-06www.mobile-coach.eu
- Not checked yetcites [17] source
- Not checked yetcites [68] source
- Not checked yetcites [77] source
- Not checked yetcites [78] source
- Not checked yetcites [79] source
- Not checked yetcites [85] source
- Not checked yetcites [86] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Affecting approximately 235 million people, asthma is one of the most common chronic diseases worldwide [20].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
- Not checked yetcites [20] Asthma Fact SheetWorld Health Organization2020-04-13https://www.who.int/en/news-room/fact-sheets/detail/asthma
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“and treatment success [18].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
- Not checked yetcites [18] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Another common concern is poor technique during medication inhalation, leading to reduced dispersion of the drug in the lungs, and subsequent decreased asthma stability and lowered clinical effectiveness of the delivered drug [41-44].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Compared to very similar conversational agent research targeting childhood obesity [68], physical inactivity [77], or the management of chronic pain [17], this intervention resulted in a high overall therapeutic goal achievement rate (75.5%) but also in improved asthma knowledge test scores and behavioral skills (ie, no identified inhalation mistakes occurred after the feedback from health care”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Digital health interventions in the form of mobile apps can be particularly effective for children as they provide an attractive channel for education and management through the possible integration of multimedia content such as audio or video [19].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Introduction
What the sources say
- Not checked yetcites [19] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results of this first feasibility study indicate an overall positive evaluation with respect to the reach of the intervention (ie, 49.5% of 99 young patients approached did install the app and started to interact with the MAX conversational agent), the strong working alliance between patients and the MAX conversational agent, and high acceptance of the intervention by all relevant stakeholders”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
hedgedn = 99- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The single-item measures used to assess technology acceptance are sufficient to validly measure the constructs.
None of the sources cited for this claim have been checked yet.
In the paper
“Knowledge about asthma (ie, cognitive skill) was assessed at the beginning of the intervention (ie, at the end of the introductory chat with the conversational agent MAX) and in the last session by a validated health literacy quiz for children with asthma, with a quiz score ranging from 0 (no knowledge) to 11 (good knowledge) [80,94] (see Multimedia Appendix 19).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
What the sources say
- Not checked yetcites [80] SchnyderMASantschiRAuf Spurensuche im FerienlagerEin Lerncomic über Asthma20122020-04-13https://www.lungenliga.ch/uploads/tx_pubshop/Lerncomic_Spurensuche.pdf
- Not checked yetcites [94] Schnyder, M, 2014, Begleitbericht Zur Entwicklung eines Lernmittels für Asthmakinder im Alter von 7 bis 12 Jahren
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“It was previously suggested that conversational agents can be influential and engaging for young patients, and that open-text answers are highly appreciated [104].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
What the sources say
- Not checked yetcites [104] source
hedged- Asserted: fails — The authors may not put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“perceived usefulness (“The app helped me to increase my knowledge about my asthma”), ease of use (“The app was easy to use”), enjoyment (“I found the app enjoyable”), control (“I could control many aspects of the app”), and usage intention (“How much would you like to continue working with MAX?”) were assessed by patients at the end of the intervention with instruments adapted from information”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“We minimized the risk for smartphone addiction [76] by limiting the amount of possible sessions to one per day and further including active exercises outside the digital environment of the app to increase social interaction and to counteract increasing smartphone usage among children [103].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The study was approved by the institutional review board of ETH Zurich (reference number: EK 2018-N-59).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Digital health interventions for asthma include numerous mobile health apps that provide patients with information and help them track symptoms or medications, often using a gamification component [45-47].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Comparison With Prior Work
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“General ongoing costs include keeping the intervention content updated according to recent asthma management guidelines (at a cost of approximately US $10,000 every 3 years) and maintaining technical software (at a cost of approximately US $10,000 per year).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: The MAX project team's cost estimates are accurate.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, the study was exploratory by nature and did not include a detailed power analysis to determine a particular sample size.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, privacy issues with conversational agents and open-text answers were pointed out by prior work [105], as conversational agents that are responsive to such inputs could potentially and unintentionally retrieve more and more personal information.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
What the sources say
- Not checked yetcites [105] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“It was previously suggested that conversational agents can be influential and engaging for young patients, and that open-text answers are highly appreciated [104].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
What the sources say
- Not checked yetcites [104] source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Specifically, some data had to be stored in a redundant way (eg, contact number, patient name) in the MAX system, which likely resulted in an overestimation of efforts (eg, the duration of the onboarding process).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Based on our limited sample, it is clear that the results are not representative and must be interpreted with caution.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, it is not clear whether and to what degree the MAX intervention would work the same way with other relevant health care professionals such as a general practitioner.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
hedgedn = 2- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In case none of these additional intervention components or studies is considered, estimates of the MAX project team indicate that the development of the current MAX intervention into a “product” would cost another US $100,000.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: The MAX project team's cost estimates are accurate.
None of the sources cited for this claim have been checked yet.
In the paper
“For example, there is evidence that the number of nocturnal cough events is negatively correlated with asthma control [106,107], and that nocturnal cough in adult asthma patients can be detected reliably with the microphone of a smartphone [89,108].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We have demonstrated that conversational agents can take over the role of a mediating social actor in a complex health care setting with various stakeholders, and deliver a digital health intervention in a scalable way into the everyday life of patients and their family members.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Conclusions
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The MAX intervention can be delivered in a scalable way into the everyday life of patients and their family members.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, we have only reported the costs and efforts related to the MAX intervention, and therefore no implications regarding cost-effectiveness can be discussed.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Working alliance between the patient and the conversational agent MAX was assessed with a German-adapted version of the Session Alliance Inventory [92] after coaching sessions 2, 8, and 14 (eg, “MAX and I respect each other” with answers anchored on a 7-point Likert scale ranging from 1 [“never”] to 8 [“always”]; see Multimedia Appendix 18).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
What the sources say
- Not checked yetcites [92] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The inhalation technique of each patient (ie, behavioral skill) was systematically assessed by the patient’s responsible health care professional with the help of predefined evaluation criteria These criteria were developed by health care professionals of the Swiss Lung Association and the participating pediatric pneumologists.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: The predefined evaluation criteria used by health care professionals validly assess inhalation technique.
- Rests on an assumption: The health care professionals' assessments of inhalation technique are reliable.
None of the sources cited for this claim have been checked yet.
In the paper
“For example, there is evidence that the number of nocturnal cough events is negatively correlated with asthma control [106,107], and that nocturnal cough in adult asthma patients can be detected reliably with the microphone of a smartphone [89,108].”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“However, privacy issues with conversational agents and open-text answers were pointed out by prior work [105], as conversational agents that are responsive to such inputs could potentially and unintentionally retrieve more and more personal information.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
What the sources say
- Not checked yetcites [105] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“With the MAX conversational agent, we were also able to show how to extend the reach of health care professionals into the everyday lives of patients in an efficient way without compromising the quality of care and working alliance.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For this purpose, the MAX conversational agent uses several communication channels (eg, in-app chat, email, and SMS), and therefore “lives” not only on a smartphone in the pocket of a patient but is rather omnipresent (ie, MAX appears on the phones of family members, such as via SMS, or on desktop or tablet computers of health care professionals, such as via emails and the web-based MAX interface”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Primary Findings
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“General ongoing costs include keeping the intervention content updated according to recent asthma management guidelines (at a cost of approximately US $10,000 every 3 years) and maintaining technical software (at a cost of approximately US $10,000 per year).”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: The MAX project team's cost estimates are accurate.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This study was designed as a feasibility study with a limited number of participants.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These nonspecialized health care experts may require significantly more time for the assessment of the inhalation video clips or would not have the expertise to do so without additional educational efforts.”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Discussion > Limitations and Future Work
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
The paper relies on this without support.
Children often face problems with technological solutions when they are not integrated into existing health care systems and do not allow for explicit support by health care professionals or family members.
“However, and in addition to shortcomings of asthma management related to cognitive and behavioral skills, children often face problems with such technological solutions when they are not integrated into existing health care systems and do not allow for explicit support by health care professionals or family members.”
The paper relies on this without support.
Without a dedicated party or mediator, it often becomes a challenge to integrate all relevant stakeholders (health care professionals, family members, and patients) into the disease management process.
“Without a dedicated party or mediator, it often becomes a challenge to integrate all of these relevant stakeholders (ie, health care professionals, family members, and the patients themselves) into the disease management process.”
The paper relies on this without support.
Conversational agents can act as mediating social actors, taking over a significant amount of intervention delivery in a scalable manner and coordinating communication among health care professionals, family members, and patients if required.
“Conversational agents, as part of such interventions, can act as mediating social actors; that is, they take over not only a significant amount of the intervention delivery in a scalable manner but also coordinate the communication among health care professionals, family members, and patients if required.”
The authors state this as an assumption.
The four distinct intervention components enabled an experiential learning cycle and were assumed to influence the outcomes of the intervention.
“Four distinct intervention components as depicted in Figure 1 enabled an experiential learning cycle [66], and were assumed to influence the outcomes of the intervention”
The authors state this as an assumption.
The need to self-regulate one’s experiences and actions (as an important predictor of engagement) is also true for digital interventions.
“Assuming that the need to self-regulate one’s experiences and actions (as an important predictor of engagement [70], as posited by self-determination theory) is also true for digital interventions”
The authors state this as an assumption.
There is a positive/negative reinforcement link that connects the outcomes of the conceptual model with the perceived characteristics of the app and working alliance with the conversational agent.
“Finally, we assume that there is a positive/negative reinforcement link that connects the outcomes of the conceptual model with the perceived characteristics of the app and working alliance with the conversational agent.”
The paper relies on this without support.
Specific cognitive skills required for asthma management include knowledge about asthma triggers and the importance of medication inhalation adherence, as well as behavioral skills such as the application of correct inhalation techniques.
“For asthma, specific cognitive skills required for disease management include knowledge about asthma triggers and the importance of medication inhalation adherence, as well as behavioral skills such as the application of correct inhalation techniques.”
The paper relies on this without support.
The predefined evaluation criteria used by health care professionals validly assess inhalation technique.
“These criteria were developed by health care professionals of the Swiss Lung Association and the participating pediatric pneumologists.”
The paper relies on this without support.
The health care professionals' assessments of inhalation technique are reliable.
“The inhalation technique of each patient (ie, behavioral skill) was systematically assessed by the patient’s responsible health care professional with the help of predefined evaluation criteria”
The paper relies on this without support.
The single-item measures used to assess technology acceptance are sufficient to validly measure the constructs.
“Single-item measures were used to reduce the burden of the intervention and answers were anchored on 7-point Likert scales ranging from “strongly disagree” (1) to “strongly agree” (7).”
The paper relies on this without support.
The observed improvements in cognitive and behavioral skills are attributable to the MAX intervention rather than other factors.
“We have shown that conversational agents framed as digital assistants of health care professionals have the potential to improve cognitive and behavioral skills in chronic disease management, with asthma in children as one specific example.”
The paper relies on this without support.
The MAX intervention can be delivered in a scalable way into the everyday life of patients and their family members.
“We have demonstrated that conversational agents can take over the role of a mediating social actor in a complex health care setting with various stakeholders, and deliver a digital health intervention in a scalable way into the everyday life of patients and their family members.”
The paper relies on this without support.
The MAX project team's cost estimates are accurate.
“In case none of these additional intervention components or studies is considered, estimates of the MAX project team indicate that the development of the current MAX intervention into a “product” would cost another US $100,000.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“relational agents—software that is designed to emulate conversations through voice or SMS text messages, also known as chatbots or digital coaches [31]—offer a compelling interface for delivering JITAIs.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Participant Characteristics
“| | Participants not finishing the intervention | 12 (25) | 129.58 (59.86) |”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Results > Participant Characteristics
“| | Participants not finishing the intervention | 12 (24) | 20.75 (15.88) |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
“a 7-point Likert scale”
§ Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study > Methods > Evaluation of the Intervention
“ranging from 1 [“never”] to 8 [“always”]”
Citations
Cites
The theory of planned behavior
Ajzen, I. (1991) · Organizational Behavior and Human Decision Processes · doi:10.1016/0749-5978(91)90020-t · Cited by 90,587
User Acceptance of Information Technology: Toward A Unified View1
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Jakob, R., Harperink, S., Rudolf, A. M., Fleisch, E., Haug, S., Mair, J. L., Salamanca-Sanabria, A., & Kowatsch, T. (2022) · Journal of Medical Internet Research · doi:10.2196/35371 · Cited by 446
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Metadata
- Authors
- Kowatsch, T., Schachner, T., Harperink, S., Barata, F., Dittler, U., Xiao, G., Stanger, C., v Wangenheim, F., Fleisch, E., Oswald, H., & Möller, A.
- Affiliations
- University of St.Gallen (CH)
- ETH Zurich (CH)
- Furtwangen University (DE)
- Johns Hopkins University (US)
- Dartmouth College (US)
- Kantonsspital Winterthur (CH)
- Corresponding author
- Kowatsch, Tobias
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2021-02-17
- Volume
- 23
- Issue
- 2
- Pages
- e25060
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7929753
- OpenAlex
- W3122673691
- Semantic Scholar
- 85bb70a2f7f6a60e2b1aba483a3e298c4e2f1dd1
- Cited by
- 103
- References
- 102
- Citations by year
- 2026: 15 · 2025: 11 · 2024: 23 · 2023: 20 · 2022: 29 · 2021: 5
- FWCI
- 21.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- Repository of Futwangen University of Applied Sciences (Furtwangen University) (submittedVersion, cc-by)
- Repository for Publications and Research Data (ETH Zurich) (submittedVersion, cc-by)
- Alexandria (UniSG) (University of St.Gallen) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- ETH Zürich Research Collection (cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Institute on Drug Abuse (P30DA029926)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124428)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Keywords
- chatbots, chronic disease management, childhood asthma, asthma self-management, therapeutic relationship, healthcare workers, inhaler technique, text messaging, intervention acceptance, feasibility, primary and secondary care, patient-centered design, family involvement in care, patient knowledge and skills
- MeSH terms
- Chronic Disease, Communication, Family, Feasibility Studies, Female, Health Personnel, Humans, Male, Patients
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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