Conversational Agents in Health Care: Scoping Review of Their Behavior Change Techniques and Underpinning Theory
Journal
Journal of Medical Internet Research
ISSN
1438-8871
Type
journal article
Date Issued
2022-10-03
Author(s)
Martinengo, Laura
;
Jabir, Ahmad Ishqi
;
Goh, Westin Wei Tin
;
Lo, Nicholas Yong Wai
;
Ho, Moon-Ho Ringo
;
;
Atun, Rifat
;
Michie, Susan
;
Tudor Car, Lorainne
Abstract
Background:
Conversational agents (CAs) are increasingly used in health care to deliver behavior change interventions. Their evaluation often includes categorizing the behavior change techniques (BCTs) using a classification system of which the BCT Taxonomy v1 (BCTTv1) is one of the most common. Previous studies have presented descriptive summaries of behavior change interventions delivered by CAs, but no in-depth study reporting the use of BCTs in these interventions has been published to date.
Objective:
This review aims to describe behavior change interventions delivered by CAs and to identify the BCTs and theories guiding their design.
Methods:
We searched PubMed, Embase, Cochrane’s Central Register of Controlled Trials, and the first 10 pages of Google and Google Scholar in April 2021. We included primary, experimental studies evaluating a behavior change intervention delivered by a CA. BCTs coding followed the BCTTv1. Two independent reviewers selected the studies and extracted the data. Descriptive analysis and frequent itemset mining to identify BCT clusters were performed.
Results:
We included 47 studies reporting on mental health (n=19, 40%), chronic disorders (n=14, 30%), and lifestyle change (n=14, 30%) interventions. There were 20/47 embodied CAs (43%) and 27/47 CAs (57%) represented a female character. Most CAs were rule based (34/47, 72%). Experimental interventions included 63 BCTs, (mean 9 BCTs; range 2-21 BCTs), while comparisons included 32 BCTs (mean 2 BCTs; range 2-17 BCTs). Most interventions included BCTs 4.1 “Instruction on how to perform a behavior” (34/47, 72%), 3.3 “Social support” (emotional; 27/47, 57%), and 1.2 “Problem solving” (24/47, 51%). A total of 12/47 studies (26%) were informed by a behavior change theory, mainly the Transtheoretical Model and the Social Cognitive Theory. Studies using the same behavior change theory included different BCTs.
Conclusions:
There is a need for the more explicit use of behavior change theories and improved reporting of BCTs in CA interventions to enhance the analysis of intervention effectiveness and improve the reproducibility of research.
Conversational agents (CAs) are increasingly used in health care to deliver behavior change interventions. Their evaluation often includes categorizing the behavior change techniques (BCTs) using a classification system of which the BCT Taxonomy v1 (BCTTv1) is one of the most common. Previous studies have presented descriptive summaries of behavior change interventions delivered by CAs, but no in-depth study reporting the use of BCTs in these interventions has been published to date.
Objective:
This review aims to describe behavior change interventions delivered by CAs and to identify the BCTs and theories guiding their design.
Methods:
We searched PubMed, Embase, Cochrane’s Central Register of Controlled Trials, and the first 10 pages of Google and Google Scholar in April 2021. We included primary, experimental studies evaluating a behavior change intervention delivered by a CA. BCTs coding followed the BCTTv1. Two independent reviewers selected the studies and extracted the data. Descriptive analysis and frequent itemset mining to identify BCT clusters were performed.
Results:
We included 47 studies reporting on mental health (n=19, 40%), chronic disorders (n=14, 30%), and lifestyle change (n=14, 30%) interventions. There were 20/47 embodied CAs (43%) and 27/47 CAs (57%) represented a female character. Most CAs were rule based (34/47, 72%). Experimental interventions included 63 BCTs, (mean 9 BCTs; range 2-21 BCTs), while comparisons included 32 BCTs (mean 2 BCTs; range 2-17 BCTs). Most interventions included BCTs 4.1 “Instruction on how to perform a behavior” (34/47, 72%), 3.3 “Social support” (emotional; 27/47, 57%), and 1.2 “Problem solving” (24/47, 51%). A total of 12/47 studies (26%) were informed by a behavior change theory, mainly the Transtheoretical Model and the Social Cognitive Theory. Studies using the same behavior change theory included different BCTs.
Conclusions:
There is a need for the more explicit use of behavior change theories and improved reporting of BCTs in CA interventions to enhance the analysis of intervention effectiveness and improve the reproducibility of research.
Language
English
HSG Classification
contribution to scientific community
HSG Profile Area
SoM - Business Innovation
Refereed
Yes
Publisher
JMIR Publications
Volume
24
Number
10
Start page
e39243
Official URL
Division(s)
Eprints ID
267512
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open.access
Name
Martinengo et al 2022 CAs Review BCTs Theory.pdf
Size
1.35 MB
Format
Adobe PDF
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