Usage and Health Effects of Embodied Conversational Agents Among Older Adults

Study Overview
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Brief Summary
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Rationale: Embodied Conversational Agents (ECAs), could be a highly effective medium to address health behaviour change among older adults. As compliance to health advice is important for positive health outcomes, successful design of persuasive ECAs can have huge health benefits. However, insights in the mechanisms underlying usage and health behaviour change via ECAs are lacking. Objective: The objective is to unravel the mechanisms behind the use of an ECA intervention, and understand the mechanism behind the observed behaviour change Study design: A randomized staggered-entry waitlist-controlled trial will be carried out. Study population: The study population consist of Dutch-speaking older adults, who live independently, are without partner, are retired, 65+ and possess basic computer skills. Intervention: The application PACO has been created for (and with) older adults with the goal to motivate them to improve their eating behaviour and decrease their feelings of loneliness. Main study parameters/endpoints: The main study parameters are use, loneliness, and eating behaviour. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Subjects are not exposed to any risks, nor have they any costs. They do have to fill in questionnaires and use the application. The duration and data collection moments are needed to gain a fine-grained understanding of the use, relationship development and health change process. For subjects, the main benefit is to gain insight in their health behaviour via the PACO-application. Although this might be experienced as confronting by some. The technology was developed based on sound theories, with input from the target group, so the investigators expect positive experiences and an improvement in participants loneliness and eating behaviour. However, this can only be proven after the study.

Official Title
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Usage and Health Effects of Embodied Conversational Agents Among Older Adults

Conditions
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Eating Behavior, Loneliness, Technology Use

Intervention / Treatment
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* Behavioral: PACO
* Behavioral: Waiting list + PACO


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Living independently at home Living without a partner No paid profession and at least 65 years of age Dutch speaking Able to use a tablet or computer Internet connection at home Exclusion Criteria: Not willing to provide inform consent

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: An unblinded randomized controlled trial. Participants in the first cohort directly receive the intervention for 8 weeks. Participants in the second cohort receive the intervention after a waiting list condition of 4 weeks, serving as a control group.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PACO<br>Participants are asked to use the intervention for eight weeks. | Behavioral: PACO<br>* The intervention is a fully-automated web-based eHealth application in which two embodied conversational agents engage in dialogue with older adults in order to motivate them towards dietary behavior change and decrease loneliness. The application consists of five different modules, each one applying different behavior change techniques.<br>|
| Other: Waiting list + PACO<br>Participants receive the same intervention, but only after a waiting period of four weeks. | Behavioral: Waiting list + PACO<br>* Waiting list + PACO<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Logdata on use application | Amount of time spend on the application during the 8 weeks intervention period | 8 weeks | 
| Change in De Jong Gierveld Loneliness Scale | Score from 1-5, higher score means a better outcome. | Four weeks before intervention to eight weeks | 
| Change in eating behaviour based on 24 hours recall |  | Four weeks before intervention to eight weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Enjoyment via affect scale | Pleasure in using the application. Score from 1-5, higher score means a better outcome. | Eight weeks after intervention | 
| Classic aesthetics Scale | The design of the application. Score from 1-7, higher score means a better outcome. | Eight weeks after intervention | 
| Concern for privacy scale | Concerns about sharing personal data, e.g.name and date of birth. Score from 1-7, higher score means a better outcome. | Four and eight weeks after intervention | 
| Active control scale | Control over the system, as perceived by the user. Score from 1-7, higher score means a better outcome. | Eight weeks after intervention | 
| System Usability Scale | Whether PACO is easy to use. Score from 1-5, higher score means a better outcome. | Eight weeks after intervention | 
| Perceived usefulness scale | Score from 1-5, higher score means a better outcome. | Eight weeks after intervention | 
| Rapport scale | Relationship with the embodied conversational agent. Score from 1-5, higher score means a better outcome. | Four weeks before intervention to eight weeks | 
| Brief Older People's Quality of Life Scake | Score from 1-5, higher score means a better outcome. | Four weeks before intervention to eight weeks | 
| Change in Basic Psychological Need Satisfaction and Frustration Scales | Score from 1-5, higher score means a better outcome. | Four weeks before intervention to eight weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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eHealth, Embodied Conversational Agent, Technology use