An Embodied Conversational Agent in an eHealth Self-management Intervention for Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Exploratory Study in a Real-life Setting (Preprint)

2020 ◽  
Author(s):  
Silke ter Stal ◽  
Joanne Sloots ◽  
Aniel Ramlal ◽  
Harm op den Akker ◽  
Anke Lenferink ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exploratory Study ◽  
Self Management ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Small Talk ◽  
Management Intervention ◽  
Agent Characteristics ◽  
Over Time

BACKGROUND Embodied Conversational Agents (ECAs) have the potential to stimulate actual use of eHealth applications. An ECA’s design influences the user’s perception during short interactions, but daily life evaluations of ECAs in healthcare are scarce. OBJECTIVE this is an exploratory, long-term study on the design of ECAs for eHealth. The study investigates how patients perceive the design of the ECA over time with regard to the ECA’s characteristics – friendliness, trustworthiness, involvement, expertise and authority –, small talk interaction, and likeliness of following the agent’s advice. METHODS we developed an ECA within an eHealth self-management intervention for patients with both Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF), which we offered for four months. Patients rated five agent characteristics and likeliness of following the agent’s advice before use and after three and nine weeks of use. The amount of patients’ small talk interaction was assessed by log data. Lastly, individual semi-structured interviews were used to triangulate results. RESULTS eleven patients (7 male and 4 female) with COPD and CHF participated (median age 70 years). Patients’ perceptions of the agent characteristics did not change over time (P > 0.05 for all characteristics) and only one participant finished all small talk dialogues. After three weeks of use, the patients were less likely to follow the agent’s advice (P = .01). The agent’s messages were perceived as non-personalized and the feedback as inappropriate, affecting the agent’s perceived reliability. CONCLUSIONS this exploratory study provides first insights into ECA design for eHealth. The impression of an ECA’s design seems to remain during long-term use. To investigate future added value of ECAs in eHealth, perceived reliability should be improved by managing users’ expectations of the ECA’s capabilities and creating ECA designs fitting individual needs. CLINICALTRIAL Netherlands Trial register, NL6480. Registered 14 August 2017, https://www.trialregister.nl/trial/6480

Effects of a self-management programme on patient participation in patients with chronic heart failure or chronic obstructive pulmonary disease: A randomized controlled trial

2018 ◽  
Vol 18 (3) ◽  
pp. 185-193 ◽  
Author(s):  
Kristina Luhr ◽  
Ann C Eldh ◽  
Kersti Theander ◽  
Marie Holmefur
Keyword(s):  
Heart Failure ◽  
Patient Participation ◽  
Standard Care ◽  
Controlled Trial ◽  
Management Programme ◽  
Self Management ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled

Background: Self-management strategies are crucial to patients with long-term conditions and can presumably promote patient participation, given that to patients, patient participation connotes opportunities for self-care (along with being engaged in an exchange of knowledge, a phrasing of joint goals and planning of care). So far, limited attention has been given to what components support self-management and what outcomes can be achieved. An exclusive self-management programme in primary healthcare entailed assessing its influence on patient participation. Aim: To describe the effects of a self-management programme on preferences for, and experiences of, patient participation in patients with chronic obstructive pulmonary disease or chronic heart failure. Methods: A randomized controlled trial with a six session intervention programme, including phrasing of individual action plans and group discussions on the patients’ issues. The intervention group ( n=59) received standard care and the self-management programme, and the control group ( n=59) received standard care only. Data was collected at baseline and at three months and 12 months after the intervention started, using the Patient Preferences for Patient Participation (the 4Ps) measure. Results: No significant differences were found within the groups, or between the groups, in preferences and experiences of patient participation, either in summary score or at an item level. Conclusion: A self-management group programme led by trained primary healthcare staff in primary care did not serve as means to influence patients’ experience of patient participation in the care of their long-term condition. Further studies are needed in regard to what facilitates patient participation in this setting and beyond.

scholarly journals Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study (Preprint)

2020 ◽  
Author(s):  
Laura Kooij ◽  
Petra J E Vos ◽  
Antoon Dijkstra ◽  
Wim H van Harten
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Clinical Practice ◽  
Technology Acceptance ◽  
Mobile Health ◽  
Self Management ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Management Interventions ◽  
And Coping ◽  
Over Time

BACKGROUND Mobile health and self-management interventions may positively affect behavioral change and reduce hospital admissions for patients with chronic obstructive pulmonary disease (COPD). However, not all patients qualify for these interventions, and systematic, comprehensive information on implementation- and compliance-related aspects of mobile self-management apps is lacking. Due to the tendency to target digital services to patients in stable phases of disease, it is especially relevant to focus on the use of these services in broad clinical practice for patients recently discharged from hospital. OBJECTIVE This study aims to evaluate the effects of a mobile health and self-management app in clinical practice for recently discharged patients with COPD on use of the app, self-management, expectations, and experiences (technology acceptance); patients’ and nurses’ satisfaction; and hospital readmissions. METHODS A prototype of the app was pilot tested with 6 patients with COPD. The COPD app consisted of an 8-week program including the Lung Attack Action Plan, education, medication overview, video consultation, and questionnaires (monitored by nurses). In the feasibility study, adult patients with physician-diagnosed COPD, access to a mobile device, and proficiency of the Dutch language were included from a large teaching hospital during hospital admission. Self-management (Partners in Health Scale), technology acceptance (Unified Theory Acceptance and Use of Technology model), and satisfaction were assessed using questionnaires at baseline, after 8 weeks, and 20 weeks. Use was assessed with log data, and readmission rates were extracted from the electronic medical record. RESULTS A total of 39 patients were included; 76.4% (133/174) of patients had to be excluded from participation, and 48.9% of those patients (65/133) were excluded because of lack of digital skills, access to a mobile device, or access to the internet. The COPD app was opened most often in the first week (median 6.0; IQR 3.5-10.0), but its use decreased over time. The self-management element knowledge and coping increased significantly over time (<i>P</i>=.04). The COPD app was rated on a scale of 1-10, with an average score by patients of 7.7 (SD 1.7) and by nurses of 6.3 (SD 1.2). Preliminary evidence about the readmission rate showed that 13% (5/39) of patients were readmitted within 30 days; 31% (12/39) of patients were readmitted within 20 weeks, compared with 14.1% (48/340) and 21.8% (74/340) in a preresearch cohort, respectively. CONCLUSIONS The use of a mobile self-management app after hospital discharge seems to be feasible only for a small number of patients with COPD. Patients were satisfied with the service; however, use decreased over time, and only knowledge and coping changed significantly over time. Therefore, future research on digital self-management interventions in clinical practice should focus on including more difficult subgroups of target populations, a multidisciplinary approach, technology-related aspects (such as acceptability), and fine-tuning its adoption in clinical pathways. CLINICALTRIAL Clinicaltrials.gov NCT04540562; https://clinicaltrials.gov/ct2/show/NCT04540562.

Sign in / Sign up

Export Citation Format

Share Document