Embodied Conversational Agents in eHealth:How Facial and Textual Expressions of Positive and Neutral Emotions Influence Perceptions of Mutual Understanding

Embodied conversational agents (ECAs) could engage users in eHealth by building mutual understanding (i.e. rapport) via emotional expressions. We compared an ECA’s emotions expressed in text with an ECA’s emotions in facial expressions on users’ perceptions of rapport. We used a 2×2 design, combining a happy or neutral facial expression with a happy or neutral textual expression. Sixty-three participants (mean, 48±22 years) had a dialogue with an ECA on healthy living and rated multiple rapport items. Results show that participants’ perceived rapport for an ECA with a happy facial expression and neutral textual expression and an ECA with a neutral facial expression and happy textual expression was significantly higher than the neutral value of the rapport scale (⁠P=0.049 and P=0.008⁠, respectively). Furthermore, results show no significant difference in overall rapport between the conditions (⁠P=0.062⁠), but a happy textual expression for an ECA with a neutral facial expression shows higher ratings of the individual rapport items helpfulness (⁠P=0.019⁠) and enjoyableness (⁠P=0.028⁠). Future research should investigate users’ rapport towards an ECA with different emotions in long-term interaction and how a user’s age and personality and an ECA’s animations affect rapport building. Optimizing rapport building between a user and an ECA could contribute to achieving long-term interaction with eHealth

Look who's talking: appearance of embodied conversational agents in eHealth

As we live longer and more people develop chronic diseases, the demand for care increases. The focus of our health care has to shift from curing acute complaints to (secondary) prevention of com¬plaints via long-term care and coaching. A solution widely investigated to offer this long-term care and coaching is eHealth. But, for eHealth applications to be effective, use of the applications is crucial. In that sense, engagement with an eHealth application is necessary; those who are more engaged are significantly less likely to stop using it. To engage users in long-term care and coaching, Embodied Conversational Agents (ECAs) can be used. As humans, we immediately form ideas about such ECAs based on their appearance when we interact with them for the first time, similar to what we do when interacting with another human for the first time. Then, when we have a positive first impression of another human, we tend to interact more with that human. This might also apply to our interaction with ECAs. Therefore, ECAs could stimulate users to start or continue interacting with the underlying eHealth application (at first glance or after short interaction respectively) to eventually reach long-term interaction. By researching how an ECA’s appearance should be designed to trigger positive impressions in these different phases of interaction, we can stimulate users to continue to next phase and eventually reach long-term engagement. The main aim of this thesis was: How to design the appearance of an ECA in eHealth to promote user engagement? The sub objectives of this thesis were: 1) How to design the appearance of an ECA in eHealth for positive impressions at first glance?, 2) How to design the appearance of an ECA in eHealth for positive impressions after short interaction? and 3) How to design the appearance of an ECA in eHealth for positive impressions after long-term interaction

Embodied conversational agent appearance for health assessment of older adults: Explorative study

Background: Embodied conversational agents (ECAs) have great potential for health apps but are rarely investigated as part of such apps. To promote the uptake of health apps, we need to understand how the design of ECAs can influence the preferences, motivation, and behavior of users. Objective: This is one of the first studies that investigates how the appearance of an ECA implemented within a health app affects users' likeliness of following agent advice, their perception of agent characteristics, and their feeling of rapport. In addition, we assessed usability and intention to use. Methods: The ECA was implemented within a frailty assessment app in which three health questionnaires were translated into agent dialogues. In a within-subject experiment, questionnaire dialogues were randomly offered by a young female agent or an older male agent. Participants were asked to think aloud during interaction. Afterward, they rated the likeliness of following the agent's advice, agent characteristics, rapport, usability, and intention to use and participated in a semistructured interview. Results: A total of 20 older adults (72.2 [SD 3.5] years) participated. The older male agent was perceived as more authoritative than the young female agent (P=.03), but no other differences were found. The app scored high on usability (median 6.1) and intention to use (median 6.0). Participants indicated they did not see an added value of the agent to the health app. Conclusions: Agent age and gender little influence users' impressions after short interaction but remain important at first glance to lower the threshold to interact with the agent. Thus, it is important to take the design of ECAs into account when implementing them into health apps

Who Do You Prefer? The Effect of Age, Gender and Role on Users’ First Impressions of Embodied Conversational Agents in eHealth

Embodied conversational agents may be used to engage users in adopting eHealth applications. The aim of this research is to investigate which design features establish a positive first impression of an agent in this context. A set of eight static agent images, different in age, gender and role, were subjected to testing in an online questionnaire. Respondents (n = 155) selected their preferred design and rated the characteristics–friendliness, expertise, reliability, involvement and authority–and the likeliness of following the agent’s advice for all designs. In addition, focus groups (n = 13) were conducted for detailed understandings supporting these impressions. Our results show that, for both a general and elderly population, (1) people seem to prefer images of young, female agents over old, male agents, (2) the (a) age, (b) gender and (c) role of the agent image affect the perception of the agent’s characteristics and the likeliness of following the agent’s advice, and that (3) both the general and elderly population prefer an agent image that is similar in (a) age and (b) gender. A next step would be to investigate how the characteristics of the agent designs are perceived after interaction with the agent

Design Features of Embodied Conversational Agents in eHealth : a Literature Review

Embodied conversational agents (ECAs) are gaining interest to elicit user engagement and stimulate actual use of eHealth applications. In this literature review, we identify the researched design features for ECAs in eHealth, the outcome variables that were used to measure the effect of these design features and what the found effects for each variable were. Searches were performed in Scopus, ACM Digital Library, PsychINFO, Pubmed and IEEE Xplore Digital Library, resulting in 1284 identified articles of which 33 articles were included. The agents speech and/or textual output and its facial and gaze expressions were the most common design features. Little research was performed on the agent's looks. The measured effect of these design features was often on the perception of the agent's and user's characteristics, relation with the agent, system usage, intention to use, usability and behaviour change. Results show that emotion and relational behaviour seem to positively affect the perception of the agents characteristics and that relational behaviour also seems to positively affect the relation with the agent, usability and intention to use. However, these design features do not necessarily lead to behaviour change. This review showed that consensus on design features of ECAs in eHealth is far from established. Follow-up research should include more research on the effects of all design features, especially research on the effects in a long-term, daily life setting, and replication of studies on the effects of design features performed in other contexts than eHealth.</p

Designing a smart toy interactive setting for creating stories: From free play to story structure and reflection support

Smart and robotic toys introduce more possibilities than ever for building interactive settings for playful learning. Here we explore their use for supporting the development of storytelling skills in children. Previous research on interactive storytelling prototypes has already shown their potential to this end. However, the focus has often been set on technical implementation issues or using very specialized hardware that may limit their potential to go outside the lab. The lack of a general and integrated application with off-the-shelf affordable components has encouraged our research on how to combine a tablet application with an existing smart robotic toy, so that it supports the creation of structured stories and children’s reflection on them. Thus, this paper reports on the design and development of a multimedia storytelling application that includes a smart robotic toy, adopting a user-centric approach with iterative design and user-testing cycles

Developing Embodied Conversational Agents for Coaching People in a Healthy Lifestyle: Scoping Review

BACKGROUND: Embodied conversational agents (ECAs) are animated computer characters that simulate face-to-face counseling. Owing to their capacity to establish and maintain an empathic relationship, they are deemed to be a promising tool for starting and maintaining a healthy lifestyle. OBJECTIVE: This review aimed to identify the current practices in designing and evaluating ECAs for coaching people in a healthy lifestyle and provide an overview of their efficacy (on behavioral, knowledge, and motivational parameters) and use (on usability, usage, and user satisfaction parameters). METHODS: We used the Arksey and O'Malley framework to conduct a scoping review. PsycINFO, Medical Literature Analysis and Retrieval System Online, and Scopus were searched with a combination of terms related to ECA and lifestyle. Initially, 1789 unique studies were identified; 20 studies were included. RESULTS: Most often, ECAs targeted physical activity (n=16) and had the appearance of a middle-aged African American woman (n=13). Multiple behavior change techniques (median=3) and theories or principles (median=3) were applied, but their interpretation and application were usually not reported. ECAs seemed to be designed for the end user rather than with the end user. Stakeholders were usually not involved. A total of 7 out of 15 studies reported better efficacy outcomes for the intervention group, and 5 out of 8 studies reported better use-related outcomes, as compared with the control group. CONCLUSIONS: ECAs are a promising tool for persuasive communication in the health domain. This review provided valuable insights into the current developmental processes, and it recommends the use of human-centered, stakeholder-inclusive design approaches, along with reporting on the design activities in a systematic and comprehensive manner. The gaps in knowledge were identified on the working mechanisms of intervention components and the right timing and frequency of coaching.</p