Automated vs. Human Health Coaching

Health coaching can be an effective intervention to support self-management of chronic conditions like diabetes, but there are not enough coaching practitioners to reach the growing population in need of support. Conversational technology, like chatbots, presents an opportunity to extend health coaching support to broader and more diverse populations. However, some have suggested that the human element is essential to health coaching and cannot be replicated with technology. In this research, we examine automated health coaching using a theory-grounded, wizard-of-oz chatbot, in comparison with text-based virtual coaching from human practitioners who start with the same protocol as the chatbot but have the freedom to embellish and adjust as needed. We found that even a scripted chatbot can create a coach-like experience for participants. While human coaches displayed advantages expressing empathy and using probing questions to tailor their support, they also encountered tremendous barriers and frustrations adapting to text-based virtual coaching. The chatbot coach had advantages in being persistent, as well as more consistently giving choices and options to foster client autonomy. We discuss implications for the design of virtual health coaching interventions.

[1]  Jessica S. Ancker,et al.  Good intentions are not enough: how informatics interventions can worsen inequality , 2018, J. Am. Medical Informatics Assoc..

[2]  Steve Whittaker,et al.  The character, functions, and styles of instant messaging in the workplace , 2002, CSCW '02.

[3]  Jodi Forlizzi,et al.  Understanding my data, myself: supporting self-reflection with ubicomp technologies , 2011, UbiComp '11.

[4]  Gunnar Ellingsen,et al.  A Review of 25 Years of CSCW Research in Healthcare: Contributions, Challenges and Future Agendas , 2012, Computer Supported Cooperative Work (CSCW).

[5]  Enrico Coiera,et al.  Measuring User Experience in Conversational Interfaces: A Comparison of Six Questionnaires , 2018 .

[6]  Jessica A. Chen,et al.  Conversational agents in healthcare: a systematic review , 2018, J. Am. Medical Informatics Assoc..

[7]  Quoc V. Le,et al.  Towards a Human-like Open-Domain Chatbot , 2020, ArXiv.

[8]  Sean A. Munson,et al.  Boundary Negotiating Artifacts in Personal Informatics: Patient-Provider Collaboration with Patient-Generated Data , 2015, CSCW.

[9]  Diana Sherifali,et al.  Evaluating the Effect of a Diabetes Health Coach in Individuals with Type 2 Diabetes. , 2016, Canadian journal of diabetes.

[10]  Youngin Kim,et al.  Usefulness of a Novel Mobile Diabetes Prevention Program Delivery Platform With Human Coaching: 65-Week Observational Follow-Up , 2018, JMIR mHealth and uHealth.

[11]  Jeffrey Heer,et al.  Design Considerations for Collaborative Visual Analytics , 2008, Inf. Vis..

[12]  David M Nathan,et al.  10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. , 2009, Lancet.

[13]  Benjamin R. Cowan,et al.  What Makes a Good Conversation?: Challenges in Designing Truly Conversational Agents , 2019, CHI.

[14]  Ambuj Tewari,et al.  An Actor-Critic Contextual Bandit Algorithm for Personalized Mobile Health Interventions , 2017, ArXiv.

[15]  Geraldine Fitzpatrick,et al.  Understanding the Mundane Nature of Self-care: Ethnographic Accounts of People Living with Parkinson's , 2018, CHI.

[16]  Sarah Sharples,et al.  Voice Interfaces in Everyday Life , 2018, CHI.

[17]  B. Weiss,et al.  Quick Assessment of Literacy in Primary Care: The Newest Vital Sign , 2005, The Annals of Family Medicine.

[18]  Wijnand A. IJsselsteijn,et al.  Beyond Behavior: The Coach's Perspective on Technology in Health Coaching , 2019, CHI.

[19]  Seth M Noar,et al.  Efficacy of text messaging-based interventions for health promotion: a meta-analysis. , 2013, Social science & medicine.

[20]  Laura Johnson,et al.  How Many Interviews Are Enough? , 2006 .

[21]  Lihong Li,et al.  Neural Approaches to Conversational AI , 2019, Found. Trends Inf. Retr..

[22]  Bonnie J Nesbitt,et al.  Health Coaching to Improve Healthy Lifestyle Behaviors: An Integrative Review , 2010, American journal of health promotion : AJHP.

[23]  Rosalind W. Picard,et al.  Establishing the computer-patient working alliance in automated health behavior change interventions. , 2005, Patient education and counseling.

[24]  Mary Williamson,et al.  Recipes for Building an Open-Domain Chatbot , 2020, EACL.

[25]  Timothy Bickmore,et al.  Taking the time to care: empowering low health literacy hospital patients with virtual nurse agents , 2009, CHI.

[26]  Adam S. Miner,et al.  Smartphone-Based Conversational Agents and Responses to Questions About Mental Health, Interpersonal Violence, and Physical Health. , 2016, JAMA internal medicine.

[27]  Sean A. Munson,et al.  Supporting Patient-Provider Collaboration to Identify Individual Triggers using Food and Symptom Journals , 2017, CSCW.

[28]  Walter S. Lasecki,et al.  Identifying Challenges and Opportunities in Human-AI Collaboration in Healthcare , 2019, CSCW Companion.

[29]  J. Marcin,et al.  Addressing health disparities in rural communities using telehealth , 2016, Pediatric Research.

[30]  Kenton O'Hara,et al.  Talking with Conversational Agents in Collaborative Action , 2017, CSCW Companion.

[31]  Martin Härter,et al.  The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. , 2010, Patient education and counseling.

[32]  Zhou Yu,et al.  Human-Agent Communication: Connecting Research and Development in HCI and AI , 2019, CSCW Companion.

[33]  Frank Bentley,et al.  Panel: Voice Assistants, UX Design and Research , 2018, CHI Extended Abstracts.

[34]  T. Bodenheimer,et al.  Patient self-management of chronic disease in primary care. , 2002, JAMA.

[35]  Chia-Fang Chung,et al.  Supporting patient-provider communication and engagement with personal informatics data , 2017, UbiComp/ISWC Adjunct.

[36]  Jean-Claude Martin,et al.  WEnner: A Theoretically Motivated Approach for Tailored Coaching about Physical Activity , 2018, UbiComp/ISWC Adjunct.

[37]  Berry Eggen,et al.  Understanding the implications of social translucence for systems supporting communication at work , 2008, CSCW.

[38]  Andreea Danielescu,et al.  A Bot is Not a Polyglot: Designing Personalities for Multi-Lingual Conversational Agents , 2018, CHI Extended Abstracts.

[39]  Saul Greenberg,et al.  Prototyping an intelligent agent through Wizard of Oz , 1993, INTERCHI.

[40]  M. Barry,et al.  Shared decision making--pinnacle of patient-centered care. , 2012, The New England journal of medicine.

[41]  Melanie Jay,et al.  Brief Action Planning to Facilitate Behavior Change and Support Patient Self , 2014 .

[42]  K. Fitzpatrick,et al.  Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial , 2017, JMIR mental health.

[43]  Lena Mamykina,et al.  MAHI: investigation of social scaffolding for reflective thinking in diabetes management , 2008, CHI.

[44]  R. Morris,et al.  Towards an Artificially Empathic Conversational Agent for Mental Health Applications: System Design and User Perceptions , 2018, Journal of medical Internet research.

[45]  K. Á. T.,et al.  Towards a tool for the Subjective Assessment of Speech System Interfaces (SASSI) , 2000, Natural Language Engineering.

[46]  Naphtali Rishe,et al.  I Can Help You Change! An Empathic Virtual Agent Delivers Behavior Change Health Interventions , 2013, TMIS.

[47]  Joelle Pineau,et al.  A Survey of Available Corpora for Building Data-Driven Dialogue Systems , 2015, Dialogue Discourse.

[48]  Jonathan Grudin,et al.  Chatbots, Humbots, and the Quest for Artificial General Intelligence , 2019, CHI.

[49]  Xianghua Ding,et al.  Boundary Negotiation for Patient-Provider Communication via WeChat in China , 2019, Proc. ACM Hum. Comput. Interact..

[50]  Sean A. Munson,et al.  Effects of Public Commitments and Accountability in a Technology-Supported Physical Activity Intervention , 2015, CHI.

[51]  Susan R. Fussell,et al.  Effects of Conversational Involvement Cues on Understanding and Emotions in Instant Messaging Conversations , 2016 .

[52]  Herbert H. Clark,et al.  Grounding in communication , 1991, Perspectives on socially shared cognition.

[53]  Albert A. Rizzo,et al.  Reporting Mental Health Symptoms: Breaking Down Barriers to Care with Virtual Human Interviewers , 2017, Front. Robot. AI.

[54]  A. Greene,et al.  Patients’ Engagement With “Sweet Talk” – A Text Messaging Support System for Young People With Diabetes , 2008, Journal of medical Internet research.

[55]  Gary A. Sforzo,et al.  A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral intervention in Healthcare , 2013, Global advances in health and medicine.

[56]  R. Daft,et al.  Information Richness. A New Approach to Managerial Behavior and Organization Design , 1983 .

[57]  Enrico Coiera,et al.  The Personalization of Conversational Agents in Health Care: Systematic Review , 2019, Journal of medical Internet research.

[58]  Ambuj Tewari,et al.  Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support , 2017, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[59]  Jeanette M Olsen,et al.  Health coaching: a concept analysis. , 2014, Nursing forum.

[60]  Sun Young Park,et al.  Beyond Health Literacy: Supporting Patient-Provider Communication during an Emergency Visit , 2017, CSCW.

[61]  Deborah A. Greenwood,et al.  A Systematic Review of Reviews Evaluating Technology-Enabled Diabetes Self-Management Education and Support , 2017, Journal of diabetes science and technology.

[62]  T. Bickmore,et al.  A Randomized Controlled Trial of an Automated Exercise Coach for Older Adults , 2013, Journal of the American Geriatrics Society.

[63]  Filip Radlinski,et al.  Towards Conversational Recommender Systems , 2016, KDD.

[64]  D. Bravata,et al.  Remote Lifestyle Coaching Plus a Connected Glucose Meter with Certified Diabetes Educator Support Improves Glucose and Weight Loss for People with Type 2 Diabetes , 2018, Journal of diabetes research.

[65]  Sayali S. Phatak,et al.  Adaptive step goals and rewards: a longitudinal growth model of daily steps for a smartphone-based walking intervention , 2018, Journal of Behavioral Medicine.

[66]  R. Rubin,et al.  Access to Diabetes Self-management Education , 2009, The Diabetes educator.

[67]  Rafal Kocielnik,et al.  Conversational Agents for Health and Wellbeing , 2020, CHI Extended Abstracts.

[68]  Mark W. Newman,et al.  "My blood sugar is higher on the weekends": Finding a Role for Context and Context-Awareness in the Design of Health Self-Management Technology , 2019, CHI.

[69]  J. Shaw,et al.  Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. , 2019, Diabetes research and clinical practice.

[70]  Wendy A. Kellogg,et al.  Social translucence: an approach to designing systems that support social processes , 2000, TCHI.

[71]  Jodi Forlizzi,et al.  A stage-based model of personal informatics systems , 2010, CHI.

[72]  Lawrence R. Ness,et al.  Are We There Yet - Data Saturation in Qualitative Research (TQR Published).pdf , 2015 .

[73]  Laura A. Petersen,et al.  Racial and ethnic disparities in the use of health services , 2003, Journal of General Internal Medicine.

[74]  Sean A. Munson,et al.  Exploring goal-setting, rewards, self-monitoring, and sharing to motivate physical activity , 2012, 2012 6th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth) and Workshops.

[75]  Christoph Trattner,et al.  Towards Health (Aware) Recommender Systems , 2017, DH.

[76]  N. Ramchandani,et al.  Virtual Coaching to Enhance Diabetes Care. , 2019, Diabetes technology & therapeutics.

[77]  David W. McDonald,et al.  Building for social translucence: a domain analysis and prototype system , 2012, CSCW '12.

[78]  Paul J. Feltovich,et al.  Common Ground and Coordination in Joint Activity , 2005 .

[79]  Victor M. Montori,et al.  Shared Decision-Making in Diabetes Care , 2015, Current Diabetes Reports.

[80]  Anind K. Dey,et al.  Understanding and Using Context , 2001, Personal and Ubiquitous Computing.

[81]  Elena Mugellini,et al.  Food Diary Coaching Chatbot , 2018, UbiComp/ISWC Adjunct.

[82]  E. Coiera.  When conversation is better than computation. , 2000, Journal of the American Medical Informatics Association : JAMIA.

[83]  Jessica Hammer,et al.  Beyond Dyadic Interactions: Considering Chatbots as Community Members , 2019, CHI.

[84]  N. Owen,et al.  Living Well With Diabetes: 24-Month Outcomes From a Randomized Trial of Telephone-Delivered Weight Loss and Physical Activity Intervention to Improve Glycemic Control , 2014, Diabetes Care.

[85]  Laura R. Saslow,et al.  Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report , 2019, Diabetes Care.

[86]  Wanda Pratt,et al.  How to evaluate technologies for health behavior change in HCI research , 2011, CHI.

[87]  Lena Mamykina,et al.  Participatory approach to the development of a knowledge base for problem-solving in diabetes self-management , 2016, Int. J. Medical Informatics.

[88]  G. Eysenbach,et al.  Asynchronous and Synchronous Teleconsultation for Diabetes Care: A Systematic Literature Review , 2010, Journal of diabetes science and technology.

[89]  Bilge Mutlu,et al.  MACH: my automated conversation coach , 2013, UbiComp.

[90]  Bart Kamphorst,et al.  E-coaching systems - What they are, and what they aren't , 2017, Pers. Ubiquitous Comput..

[91]  Mary Czerwinski,et al.  Pocket Skills: A Conversational Mobile Web App To Support Dialectical Behavioral Therapy , 2018, CHI.

[92]  Joseph Weizenbaum,et al.  ELIZA—a computer program for the study of natural language communication between man and machine , 1966, CACM.

[93]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[94]  Yi Zhang,et al.  Conversational Recommender System , 2018, SIGIR.

[95]  Amanda K. Hall,et al.  Mobile text messaging for health: a systematic review of reviews. , 2015, Annual review of public health.

[96]  Lena Mamykina,et al.  Data-driven health management: reasoning about personally generated data in diabetes with information technologies , 2016, J. Am. Medical Informatics Assoc..

[97]  J. F. Kelley,et al.  An iterative design methodology for user-friendly natural language office information applications , 1984, TOIS.