A Virtual Agent to Support Individuals Living With Physical and Mental Comorbidities: Co-Design and Acceptability Testing

Abstract

Background: Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on an individual's levels of emotional distress, health outcomes, and associated health care utilization. As health care services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent (chatbot, conversational agent), which uses artificial intelligence (AI) to process the user's written or spoken natural language and then to select or construct the corresponding appropriate responses.

Objective: This study aimed to co-design the content, functionality, and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (LTC; chronic pulmonary obstructive disease [COPD]) and then to assess the acceptability and system content.

Methods: We conducted 2 co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care.

Results: Adults (n=6) with a diagnosis of COPD and health professionals (n=5) specified 4 priority self-management scenarios for which they would like to receive support: at the time of diagnosis (information provision), during acute exacerbations (crisis support), during periods of low mood (emotional support), and for general self-management (motivation). From the scenario testing, 12 additional adults with COPD felt the system to be both acceptable and engaging, particularly with regard to internet-of-things capabilities. They felt the system would be particularly useful for individuals living alone.

Conclusions: Patients did not explicitly separate mental and physical health needs, although the content they developed for the virtual agent had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs.

Keywords: COPD; artificial intelligence; chatbot; chronic illness; chronic obstructive pulmonary disease; comorbidity; computer-assisted therapy; conversational agent; mental health; self-management; virtual systems.

Figure 1

Persona worksheets. COPD: chronic obstructive pulmonary disease; GP: general practitioner.

Figure 2

Vignette feedback sheets. COPD: chronic obstructive pulmonary disease; GP: general practitioner; PR: pulmonary rehabilitation.

Figure 3

A day in the life of a chronic obstructive pulmonary disease patient. COPD: chronic obstructive pulmonary disease; OA: osteoarthritis.

Figure 4

User specifications for Avachat (avatar graphic shown courtesy of Bot Libre). COPD: chronic obstructive pulmonary disease; GP: general practitioner.

Figure 5

Persona crisis support. COPD: chronic obstructive pulmonary disease; 999 and 111 are the UK telephone numbers for life-threatening and non-life-threatening emergencies respectively.