Towards the Design of a Smartphone-Based Biofeedback Breathing Training: Indentifying Diaphragmatic Breathing Patterns From a Smartphones\u27 Microphone

Asthma, diabetes, hypertension, or major depression are non-communicable diseases (NCDs) and impose a major burden on global health. Stress is linked to both the causes and consequences of NCDs and it has been shown that biofeedback-based breathing trainings (BBTs) are effective in coping with stress. Here, diaphragmatic breathing, i.e. deep abdominal breathing, belongs to the most distinguished breathing techniques. However, high costs and low scalability of state-of-the-art BBTs that require expensive medical hardware and health professionals, represent a significant barrier for their widespread adoption. Health information technology has the potential to address this important practical problem. Particularly, it has been shown that a smartphone microphone has the ability to record audio signals from exhalation in a quality that can be compared to professional respiratory devices. As this finding is highly relevant for low-cost and scalable smartphone-based BBTs (SBBT) and – to the best of our knowledge - because it has not been investigated so far, we aim to design and evaluate the efficacy of such a SBBT. As a very first step, we apply design-science research and investigate in this research-in-progress the relationship of diaphragmatic breathing and its acoustic components by just using a smartphone’s microphone. For that purpose, we review related work and develop our hypotheses based on justificatory knowledge from physiology, physics and acoustics. We finally describe a laboratory study that is used to test our hypotheses. We conclude with a brief outlook on future work

Digital Souls: Designing Engaging Healthcare Chatbots

The rising global burden of chronic diseases for healthcare systems around the world is fueling the digitalization of healthcare with unprecedented speed. A broad range of novel digital health technologies are increasingly empowering patients to take charge of their own health outside clinical settings at every stage of the patient journey. Among these digital innovations, healthcare chatbots promise to simplify and humanize the access to such digital services. In this thesis, healthcare chatbots are text-based conversational agents that engage with patients in natural, written interpersonal exchanges mimicking physician-patient conversations. Yet, to promote the adoption of chatbots in healthcare, it remains of paramount importance to understand the effects of design choices that improve patient engagement and foster relationship-building processes with chatbots. Therefore, this thesis targets one major phenomenon: humans’ social responses to anthropomorphic (i.e., human-like) social cues that lead them to perceive chatbots as social actors. This dissertation proposes to unite the dual conceptualization of chatbots as communication partners and as a communication medium in one coherent research concept under the Social Response Theory and the Social Information Processing Theory. To this end, it extends the bandwidth of previously considered anthropomorphic design cues to encompass content and context cues which can carry as much social information and aid in individuals' evaluation of an interpersonal, computer-mediated interaction with a chatbot as other anthropomorphic social cues. Against this background, this thesis draws on four empirical investigations to demonstrate how content and context cues influence how other anthropomorphic cues and how single and combinations of anthropomorphic cues in healthcare chatbots affect relationship-building processes with them. First, Article I analyzes how the time horizon of a user-chatbot relationship determines a chatbot’s anthropomorphic design. Article II demonstrates how a chatbot’s social role as a context cue affects individuals’ affective bond and intentions to use it. The third article, Article III, examines how combinations of verbal content and verbal style cues facilitate the user onboarding process and impression formation in the context of initial encounters with a chatbot. Lastly, Article IV analyses how individuals’ linguacultural contexts affect their perceptions of a specific verbal style cue and interactions with a healthcare chatbot. As such, this thesis constitutes a novel approach to expanding the scope of research on designing engaging chatbots. It showcases the importance of a variety of different anthropomorphic cues that affect user engagement with healthcare chatbots. Ultimately, it provides practitioners with generalizable and actionable design guidelines that can be easily applied to various contexts

The Terms of “You(s)”: How the Term of Address Used by Conversational Agents Influences User Evaluations in French and German Linguaculture

Background: Conversational agents (CAs) are a novel approach to delivering digital health interventions. In human interactions, terms of address often change depending on the context or relationship between interlocutors. In many languages, this encompasses T/V distinction—formal and informal forms of the second-person pronoun “You”—that conveys different levels of familiarity. Yet, few research articles have examined whether CAs' use of T/V distinction across language contexts affects users' evaluations of digital health applications. Methods: In an online experiment (N = 284), we manipulated a public health CA prototype to use either informal or formal T/V distinction forms in French (“tu” vs. “vous”) and German (“du” vs. “Sie”) language settings. A MANCOVA and post-hoc tests were performed to examine the effects of the independent variables (i.e., T/V distinction and Language) and the moderating role of users' demographic profile (i.e., Age and Gender) on eleven user evaluation variables. These were related to four themes: (i) Sociability, (ii) CA-User Collaboration, (iii) Service Evaluation, and (iv) Behavioral Intentions. Results: Results showed a four-way interaction between T/V Distinction, Language, Age, and Gender, influencing user evaluations across all outcome themes. For French speakers, when the informal “T form” (“Tu”) was used, higher user evaluation scores were generated for younger women and older men (e.g., the CA felt more humanlike or individuals were more likely to recommend the CA), whereas when the formal “V form” (“Vous”) was used, higher user evaluation scores were generated for younger men and older women. For German speakers, when the informal T form (“Du”) was used, younger users' evaluations were comparable regardless of Gender, however, as individuals' Age increased, the use of “Du” resulted in lower user evaluation scores, with this effect more pronounced in men. When using the formal V form (“Sie”), user evaluation scores were relatively stable, regardless of Gender, and only increasing slightly with Age. Conclusions: Results highlight how user CA evaluations vary based on the T/V distinction used and language setting, however, that even within a culturally homogenous language group, evaluations vary based on user demographics, thus highlighting the importance of personalizing CA language.ISSN:2296-256

The Effects of Health Care Chatbot Personas With Different Social Roles on the Client-Chatbot Bond and Usage Intentions: Development of a Design Codebook and Web-Based Study

Background: The working alliance refers to an important relationship quality between health professionals and clients that robustly links to treatment success. Recent research shows that clients can develop an affective bond with chatbots. However, few research studies have investigated whether this perceived relationship is affected by the social roles of differing closeness a chatbot can impersonate and by allowing users to choose the social role of a chatbot. Objective: This study aimed at understanding how the social role of a chatbot can be expressed using a set of interpersonal closeness cues and examining how these social roles affect clients’ experiences and the development of an affective bond with the chatbot, depending on clients’ characteristics (ie, age and gender) and whether they can freely choose a chatbot’s social role. Methods: Informed by the social role theory and the social response theory, we developed a design codebook for chatbots with different social roles along an interpersonal closeness continuum. Based on this codebook, we manipulated a fictitious health care chatbot to impersonate one of four distinct social roles common in health care settings—institution, expert, peer, and dialogical self—and examined effects on perceived affective bond and usage intentions in a web-based lab study. The study included a total of 251 participants, whose mean age was 41.15 (SD 13.87) years; 57.0% (143/251) of the participants were female. Participants were either randomly assigned to one of the chatbot conditions (no choice: n=202, 80.5%) or could freely choose to interact with one of these chatbot personas (free choice: n=49, 19.5%). Separate multivariate analyses of variance were performed to analyze differences (1) between the chatbot personas within the no-choice group and (2) between the no-choice and the free-choice groups. Results: While the main effect of the chatbot persona on affective bond and usage intentions was insignificant (P=.87), we found differences based on participants’ demographic profiles: main effects for gender (P=.04, ηp2=0.115) and age (P<.001, ηp2=0.192) and a significant interaction effect of persona and age (P=.01, ηp2=0.102). Participants younger than 40 years reported higher scores for affective bond and usage intentions for the interpersonally more distant expert and institution chatbots; participants 40 years or older reported higher outcomes for the closer peer and dialogical-self chatbots. The option to freely choose a persona significantly benefited perceptions of the peer chatbot further (eg, free-choice group affective bond: mean 5.28, SD 0.89; no-choice group affective bond: mean 4.54, SD 1.10; P=.003, ηp2=0.117). Conclusions: Manipulating a chatbot’s social role is a possible avenue for health care chatbot designers to tailor clients’ chatbot experiences using user-specific demographic factors and to improve clients’ perceptions and behavioral intentions toward the chatbot. Our results also emphasize the benefits of letting clients freely choose between chatbots.ISSN:1438-887

See you soon again, chatbot? A design taxonomy to characterize user-chatbot relationships with different time horizons

Users interact with chatbots for various purposes and motivations – and for different periods of time. However, since chatbots are considered social actors and given that time is an essential component of social interactions, the question arises as to how chatbots need to be designed depending on whether they aim to help individuals achieve short-, medium- or long-term goals. Following a taxonomy development approach, we compile 22 empirically and conceptually grounded design dimensions contingent on chatbots’ temporal profiles. Based upon the classification and analysis of 120 chatbots therein, we abstract three time-dependent chatbot design archetypes: Ad-hoc Supporters, Temporary Assistants, and Persistent Companions. While the taxonomy serves as a blueprint for chatbot researchers and designers developing and evaluating chatbots in general, our archetypes also offer practitioners and academics alike a shared understanding and naming convention to study and design chatbots with different temporal profiles.ISSN:0747-5632ISSN:1873-769