Can Mental Health Chatbots Help Chronic Disease Populations?
Condition: Arthritis; Diabetes; Depression; Anxiety; Stress
MeSH terms: Arthritis; Depression
Study type: Interventional

Summary: 
      Past research has shown that patients suffering from chronic health conditions tend to
      experience high levels of negative mental health symptoms (e.g., depression). The purpose of
      the current study is to evaluate whether an artificial intelligence (A.I.) mental health
      chatbot can be used to reduce negative mental health symptoms within this population. A
      minimum of 60 individuals with a chronic health condition (diabetes or arthritis) will be
      recruited. Participants will be randomly assigned to either a treatment group or a control
      group. Those assigned to the treatment group will use the mental health chatbot Wysa
      (Touchkin eServices, Bangalore) over a period of four weeks. Those assigned to the control
      group will receive no chatbot. Participants will complete measures of depression, anxiety,
      stress, and life satisfaction via Qualtrics at the outset of the study, two weeks into the
      study, and four weeks into the study (i.e., the final assessment point). Results from the
      treatment and control groups will be compared using ANOVA models. Participants in the
      treatment group will also be asked to complete some open-ended questions about their
      experiences with the chatbot program. A subset of participants from the treatment group may
      be asked to complete optional phone or video interviews to gain a better understanding of
      their experiences. Results will provide insight into the usefulness of chatbot programs for
      reducing negative mental health symptoms among patients with a chronic health condition.
      Results may also be used to inform policy decisions about the use of these programs for
      healthcare delivery, and to provide practical insight into how these programs can be best
      integrated into healthcare settings.
    

Detailed description: 
      People dealing with chronic health conditions are susceptible to mental health issues such as
      depression and anxiety. Providing conventional mental health services to all of these
      individuals is not practical given the limited resources of the healthcare system. Artificial
      intelligence (A.I.) mental health chatbots may be an accessible and cost-effective means by
      which people can receive some degree of mental health support while they cope with their
      conditions. These automated programs act as a source of virtual support, talking with
      individuals and providing them with therapeutic exercises to improve their mental wellbeing.
      Several chatbots have been designed to deliver interventions based on popular psychological
      therapies (e.g., Wysa, Woebot, and Tess). Research has shown that these programs can reduce
      symptoms of depression, anxiety, and stress in nonclinical populations. However, the
      effectiveness of these programs has not been tested in chronic disease populations.

      The purpose of the current research is to gain a better understanding of the usefulness of
      mental health chatbots for chronic disease populations. This research will be guided by two
      fundamental objectives: (1) to determine whether a mental health chatbot can reduce or
      prevent negative mental health symptoms in individuals who are dealing with a chronic health
      condition, and (2) to learn more about how individuals with a chronic health condition view
      these programs, particularly in terms of their potential benefits or drawbacks when used in
      healthcare settings. This research will focus on two specific chronic disease populations
      that are prone to elevated levels of mental health symptoms: people with arthritis and
      diabetes.

      Participants will be recruited through social media channels (including online groups),
      newspaper advertisements, and emails and newsletters from relevant organizations (e.g., the
      Arthritis Society, Diabetes Canada). After volunteering to participate, participants will set
      up a phone or video conferencing call with the primary investigator to orient them into the
      study. Participants will be randomly assigned to either a treatment group or control group.
      Those assigned to the treatment group will download the mental health chatbot Wysa (Touchkin
      eServices, Bangalore) on their smartphones. They will interact with the chatbot a minimum of
      two times per week over a period of four weeks, with each interaction lasting a minimum of
      five minutes. Participants assigned to the control group will receive no chatbot (i.e., they
      will be in a no-treatment control group).

      Regardless of their group assignment, participants will complete online materials via
      Qualtrics at the outset of the study, two weeks into the study, and four weeks into the study
      (i.e., the final assessment point). At the outset of the study, participants will fill out an
      informed consent form, a demographic questionnaire, and four psychological assessments tools:
      measures of depression, anxiety, stress, and life satisfaction. Two weeks into the study,
      participants will complete the four psychological assessment tools a second time. Four weeks
      into the study, participants will complete the four assessment tools a final time, and those
      in the treatment group will be presented with a post-study questionnaire that contains
      qualitative questions regarding their experiences with the chatbot. Participants in both
      groups will be presented with a debriefing form providing more information about the study.
      Those in the control group will be given the opportunity to download and use the chatbot at
      this point.

      After the data from the four-week study are analyzed, a subset of participants from the
      treatment group may be asked to complete optional phone or video interviews to gain more
      insight into their experiences with and opinions on the chatbot program. Approximately 15 to
      20 participants will be sought for the interviews. The questions for these interviews will be
      developed based on the collective results from the quantitative and qualitative analysis
      described above.
    

Intervention name(s): Wysa
Intervention type(s): Device
Intervention description(s): Wysa is an AI-based mental health chatbot. It uses evidence-based techniques to help users build mental resilience skills and improve their mental health.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be assigned to one of two groups. The treatment group will use a mental health chatbot (Wysa) over a period of four weeks. The control group will receive no intervention.
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Arthritis; Diabetes; Depression; Anxiety; Stress; Chatbot; Conversational Agent