AUTHOR=Bruijnes Merijn , Kesteloo Mitchell , Brinkman Willem-Paul 

TITLE=Reducing social diabetes distress with a conversational agent support system: a three-week technology feasibility evaluation

JOURNAL=Frontiers in Digital Health

VOLUME=5

YEAR=2023

URL=https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2023.1149374

DOI=10.3389/fdgth.2023.1149374

ISSN=2673-253X

ABSTRACT=<sec><title>Background</title><p>People with diabetes mellitus not only have to deal with physical health problems, but also with the psycho-social challenges their chronic disease brings. Currently, technological tools that support the psycho-social context of a patient have received little attention.</p></sec><sec><title>Objective</title><p>The objective of this work is to determine the feasibility and preliminary efficacy of an automated conversational agent to deliver, to people with diabetes, personalised psycho-education on dealing with (psycho-)social distress related to their chronic illness.</p></sec><sec><title>Methods</title><p>In a double-blinded between-subject study, 156 crowd-workers with diabetes received a social help program intervention in three sessions over three weeks. They were randomly assigned to receive support from either an interactive conversational support agent (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM1"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>79</mml:mn></mml:math></inline-formula>) or a self-help text from the book “Diabetes burnout” as a control condition (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM2"><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>77</mml:mn></mml:math></inline-formula>). Participants completed the Diabetes Distress Scale (DDS) before and after the intervention, and after the intervention, the Client Satisfaction Questionnaire (CSQ-8), Feeling of Being Heard (FBH), and System Usability Scale (SUS).</p></sec><sec><title>Results</title><p>Results indicate that people using the conversational agent have a larger reduction in diabetes distress (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM3"><mml:mi>M</mml:mi><mml:mo>=</mml:mo><mml:mo>−</mml:mo><mml:mn>0.305</mml:mn></mml:math></inline-formula>, <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM4"><mml:mrow><mml:mi mathvariant="normal">SD</mml:mi></mml:mrow><mml:mo>=</mml:mo><mml:mn>0.865</mml:mn></mml:math></inline-formula>) than the control group (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM5"><mml:mi>M</mml:mi><mml:mo>=</mml:mo><mml:mn>0.002</mml:mn></mml:math></inline-formula>, <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM6"><mml:mrow><mml:mi mathvariant="normal">SD</mml:mi></mml:mrow><mml:mo>=</mml:mo><mml:mn>0.743</mml:mn></mml:math></inline-formula>) and this difference is statistically significant (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM7"><mml:mi>t</mml:mi><mml:mo stretchy="false">(</mml:mo><mml:mn>154</mml:mn><mml:mo stretchy="false">)</mml:mo><mml:mo>=</mml:mo><mml:mn>2.377</mml:mn></mml:math></inline-formula>, <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM8"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.019</mml:mn></mml:math></inline-formula>). A hypothesised mediation effect of “attitude to the social help program” was not observed.</p></sec><sec><title>Conclusions</title><p>An automated conversational agent can deliver personalised psycho-education on dealing with (psycho-)social distress to people with diabetes and reduce diabetes distress more than a self-help book.</p></sec><sec><title>Ethics, Study Registration and Open Science</title><p>This study has been preregistered with the Open Science Foundation (osf.io/yb6vg) and has been accepted by the Human Research Ethics Committee - Delft University of Technology under application number 1130. The data and analysis script are available: <ext-link ext-link-type="uri" xlink:href="https://surfdrive.surf.nl/files/index.php/s/4xSEHCrAu0HsJ4P" xmlns:xlink="http://www.w3.org/1999/xlink">https://surfdrive.surf.nl/files/index.php/s/4xSEHCrAu0HsJ4P</ext-link>.</p></sec>