ABSTRACT
Objective: Millions of people in the UK have asthma, yet 70% do not access basic care, leading to the largest number of asthma-related deaths in Europe. Chatbots may extend the reach of asthma support and provide a bridge to traditional healthcare. This study evaluates 'Brisa', a chatbot designed to improve asthma patients' self-assessment and self-management. Methods: We recruited 150 adults with an asthma diagnosis to test our chatbot. Participants were recruited over three waves through social media and a research recruitment platform. Eligible participants had access to 'Brisa' via a WhatsApp or website version for 28 days and completed entry and exit questionnaires to evaluate user experience and asthma control. Weekly symptom tracking, user interaction metrics, satisfaction measures, and qualitative feedback were utilised to evaluate the chatbot's usability and potential effectiveness, focusing on changes in asthma control and self-reported behavioural improvements. Results: 74% of participants engaged with 'Brisa' at least once. High task completion rates were observed: asthma attack risk assessment (86%), voice recording submission (83%) and asthma control tracking (95.5%). Post use, an 8% improvement in asthma control was reported. User satisfaction surveys indicated positive feedback on helpfulness (80%), privacy (87%), trustworthiness (80%) and functionality (84%) but highlighted a need for improved conversational depth and personalisation. Conclusions: The study indicates that chatbots are effective for asthma support, demonstrated by the high usage of features like risk assessment and control tracking, as well as a statistically significant improvement in asthma control. However, lower satisfaction in conversational flexibility highlights rising expectations for chatbot fluency, influenced by advanced models like ChatGPT. Future health-focused chatbots must balance conversational capability with accuracy and safety to maintain engagement and effectiveness.
ABSTRACT
Calibrating appropriate trust of non-expert users in artificial intelligence (AI) systems is a challenging yet crucial task. To align subjective levels of trust with the objective trustworthiness of a system, users need information about its strengths and weaknesses. The specific explanations that help individuals avoid over- or under-trust may vary depending on their initial perceptions of the system. In an online study, 127 participants watched a video of a financial AI assistant with varying degrees of decision agency. They generated 358 spontaneous text descriptions of the system and completed standard questionnaires from the Trust in Automation and Technology Acceptance literature (including perceived system competence, understandability, human-likeness, uncanniness, intention of developers, intention to use, and trust). Comparisons between a high trust and a low trust user group revealed significant differences in both open-ended and closed-ended answers. While high trust users characterized the AI assistant as more useful, competent, understandable, and humanlike, low trust users highlighted the system's uncanniness and potential dangers. Manipulating the AI assistant's agency had no influence on trust or intention to use. These findings are relevant for effective communication about AI and trust calibration of users who differ in their initial levels of trust.
ABSTRACT
BACKGROUND: Despite efforts, the UK death rate from asthma is the highest in Europe, and 65% of people with asthma in the United Kingdom do not receive the professional care they are entitled to. Experts have recommended the use of digital innovations to help address the issues of poor outcomes and lack of care access. An automated SMS text messaging-based conversational agent (ie, chatbot) created to provide access to asthma support in a familiar format via a mobile phone has the potential to help people with asthma across demographics and at scale. Such a chatbot could help improve the accuracy of self-assessed risk, improve asthma self-management, increase access to professional care, and ultimately reduce asthma attacks and emergencies. OBJECTIVE: The aims of this study are to determine the feasibility and usability of a text-based conversational agent that processes a patient's text responses and short sample voice recordings to calculate an estimate of their risk for an asthma exacerbation and then offers follow-up information for lowering risk and improving asthma control; assess the levels of engagement for different groups of users, particularly those who do not access professional services and those with poor asthma control; and assess the extent to which users of the chatbot perceive it as helpful for improving their understanding and self-management of their condition. METHODS: We will recruit 300 adults through four channels for broad reach: Facebook, YouGov, Asthma + Lung UK social media, and the website Healthily (a health self-management app). Participants will be screened, and those who meet inclusion criteria (adults diagnosed with asthma and who use WhatsApp) will be provided with a link to access the conversational agent through WhatsApp on their mobile phones. Participants will be sent scheduled and randomly timed messages to invite them to engage in dialogue about their asthma risk during the period of study. After a data collection period (28 days), participants will respond to questionnaire items related to the quality of the interaction. A pre- and postquestionnaire will measure asthma control before and after the intervention. RESULTS: This study was funded in March 2021 and started in January 2022. We developed a prototype conversational agent, which was iteratively improved with feedback from people with asthma, asthma nurses, and specialist doctors. Fortnightly reviews of iterations by the clinical team began in September 2022 and are ongoing. This feasibility study will start recruitment in January 2023. The anticipated completion of the study is July 2023. A future randomized controlled trial will depend on the outcomes of this study and funding. CONCLUSIONS: This feasibility study will inform a follow-up pilot and larger randomized controlled trial to assess the impact of a conversational agent on asthma outcomes, self-management, behavior change, and access to care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42965.
ABSTRACT
Artificial Intelligence (AI) is supposed to perform tasks autonomously, make competent decisions, and interact socially with people. From a psychological perspective, AI can thus be expected to impact users' three Basic Psychological Needs (BPNs), namely (i) autonomy, (ii) competence, and (iii) relatedness to others. While research highlights the fulfillment of these needs as central to human motivation and well-being, their role in the acceptance of AI applications has hitherto received little consideration. Addressing this research gap, our study examined the influence of BPN Satisfaction on Intention to Use (ITU) an AI assistant for personal banking. In a 2×2 factorial online experiment, 282 participants (154 males, 126 females, two non-binary participants) watched a video of an AI finance coach with a female or male synthetic voice that exhibited either high or low agency (i.e., capacity for self-control). In combination, these factors resulted either in AI assistants conforming to traditional gender stereotypes (e.g., low-agency female) or in non-conforming conditions (e.g., high-agency female). Although the experimental manipulations had no significant influence on participants' relatedness and competence satisfaction, a strong effect on autonomy satisfaction was found. As further analyses revealed, this effect was attributable only to male participants, who felt their autonomy need significantly more satisfied by the low-agency female assistant, consistent with stereotypical images of women, than by the high-agency female assistant. A significant indirect effects model showed that the greater autonomy satisfaction that men, unlike women, experienced from the low-agency female assistant led to higher ITU. The findings are discussed in terms of their practical relevance and the risk of reproducing traditional gender stereotypes through technology design.
