Meaningful human control and variable autonomy in human-robot teams for firefighting.

Introduction: Humans and robots are increasingly collaborating on complex tasks such as firefighting. As robots are becoming more autonomous, collaboration in human-robot teams should be combined with meaningful human control. Variable autonomy approaches can ensure meaningful human control over robots by satisfying accountability, responsibility, and transparency. To verify whether variable autonomy approaches truly ensure meaningful human control, the concept should be operationalized to allow its measurement. So far, designers of variable autonomy approaches lack metrics to systematically address meaningful human control. Methods: Therefore, this qualitative focus group (n = 5 experts) explored quantitative operationalizations of meaningful human control during dynamic task allocation using variable autonomy in human-robot teams for firefighting. This variable autonomy approach requires dynamic allocation of moral decisions to humans and non-moral decisions to robots, using robot identification of moral sensitivity. We analyzed the data of the focus group using reflexive thematic analysis. Results: Results highlight the usefulness of quantifying the traceability requirement of meaningful human control, and how situation awareness and performance can be used to objectively measure aspects of the traceability requirement. Moreover, results emphasize that team and robot outcomes can be used to verify meaningful human control but that identifying reasons underlying these outcomes determines the level of meaningful human control. Discussion: Based on our results, we propose an evaluation method that can verify if dynamic task allocation using variable autonomy in human-robot teams for firefighting ensures meaningful human control over the robot. This method involves subjectively and objectively quantifying traceability using human responses during and after simulations of the collaboration. In addition, the method involves semi-structured interviews after the simulation to identify reasons underlying outcomes and suggestions to improve the variable autonomy approach.

Taking a strong interactional stance.

We outline two points of criticism. Firstly, we argue that robots do constitute a separate category of beings in people's minds rather than being mere depictions of non-robotic characters. Secondly, we find that (semi-)automatic processes underpinning communicative interaction play a greater role in shaping robot-directed speech than Clark and Fischer's theory of social robots as depictions indicate.

Addressing people's current and future states in a reinforcement learning algorithm for persuading to quit smoking and to be physically active.

Behavior change applications often assign their users activities such as tracking the number of smoked cigarettes or planning a running route. To help a user complete these activities, an application can persuade them in many ways. For example, it may help the user create a plan or mention the experience of peers. Intuitively, the application should thereby pick the message that is most likely to be motivating. In the simplest case, this could be the message that has been most effective in the past. However, one could consider several other elements in an algorithm to choose a message. Possible elements include the user's current state (e.g., self-efficacy), the user's future state after reading a message, and the user's similarity to the users on which data has been gathered. To test the added value of subsequently incorporating these elements into an algorithm that selects persuasive messages, we conducted an experiment in which more than 500 people in four conditions interacted with a text-based virtual coach. The experiment consisted of five sessions, in each of which participants were suggested a preparatory activity for quitting smoking or increasing physical activity together with a persuasive message. Our findings suggest that adding more elements to the algorithm is effective, especially in later sessions and for people who thought the activities were useful. Moreover, while we found some support for transferring knowledge between the two activity types, there was rather low agreement between the optimal policies computed separately for the two activity types. This suggests limited policy generalizability between activities for quitting smoking and those for increasing physical activity. We see our results as supporting the idea of constructing more complex persuasion algorithms. Our dataset on 2,366 persuasive messages sent to 671 people is published together with this article for researchers to build on our algorithm.

Getting acquainted: First steps for child-robot relationship formation.

In this article we discuss two studies of children getting acquainted with an autonomous socially assistive robot. The success of the first encounter is key for a sustainable long-term supportive relationship. We provide four validated behavior design elements that enable the robot to robustly get acquainted with the child. The first are five conversational patterns that allow children to comfortably self-disclose to the robot. The second is a reciprocation strategy that enables the robot to adequately respond to the children's self-disclosures. The third is a 'how to talk to me' tutorial. The fourth is a personality profile for the robot that creates more rapport and comfort between the child and the robot. The designs were validated with two user studies (N 1 = 30, N 2 = 75, 8-11 years. o. children). The results furthermore showed similarities between how children form relationships with people and how children form relationships with robots. Most importantly, self-disclosure, and specifically how intimate the self-disclosures are, is an important predictor for the success of child-robot relationship formation. Speech recognition errors reduces the intimacy and feeling similar to the robot increases the intimacy of self-disclosures.

The influence of interdependence and a transparent or explainable communication style on human-robot teamwork.

Humans and robots are increasingly working together in human-robot teams. Teamwork requires communication, especially when interdependence between team members is high. In previous work, we identified a conceptual difference between sharing what you are doing (i.e., being transparent) and why you are doing it (i.e., being explainable). Although the second might sound better, it is important to avoid information overload. Therefore, an online experiment (n = 72) was conducted to study the effect of communication style of a robot (silent, transparent, explainable, or adaptive based on time pressure and relevancy) on human-robot teamwork. We examined the effects of these communication styles on trust in the robot, workload during the task, situation awareness, reliance on the robot, human contribution during the task, human communication frequency, and team performance. Moreover, we included two levels of interdependence between human and robot (high vs. low), since mutual dependency might influence which communication style is best. Participants collaborated with a virtual robot during two simulated search and rescue tasks varying in their level of interdependence. Results confirm that in general robot communication results in more trust in and understanding of the robot, while showing no evidence of a higher workload when the robot communicates or adds explanations to being transparent. Providing explanations, however, did result in more reliance on RescueBot. Furthermore, compared to being silent, only being explainable results a higher situation awareness when interdependence is high. Results further show that being highly interdependent decreases trust, reliance, and team performance while increasing workload and situation awareness. High interdependence also increases human communication if the robot is not silent, human rescue contribution if the robot does not provide explanations, and the strength of the positive association between situation awareness and team performance. From these results, we can conclude that robot communication is crucial for human-robot teamwork, and that important differences exist between being transparent, explainable, or adaptive. Our findings also highlight the fundamental importance of interdependence in studies on explainability in robots.

Using a conversational agent for thought recording as a cognitive therapy task: Feasibility, content, and feedback.

E-mental health for depression is increasingly used in clinical practice, but patient adherence suffers as therapist involvement decreases. One reason may be the low responsiveness of existing programs: especially autonomous systems are lacking in their input interpretation and feedback-giving capabilities. Here, we explore (a) to what extent a more socially intelligent and, therefore, technologically advanced solution, namely a conversational agent, is a feasible means of collecting thought record data in dialog, (b) what people write about in their thought records, (c) whether providing content-based feedback increases motivation for thought recording, a core technique of cognitive therapy that helps patients gain an understanding of how their thoughts cause their feelings. Using the crowd-sourcing platform Prolific, 308 participants with subclinical depression symptoms were recruited and split into three conditions of varying feedback richness using the minimization method of randomization. They completed two thought recording sessions with the conversational agent: one practice session with scenarios and one open session using situations from their own lives. All participants were able to complete thought records with the agent such that the thoughts could be interpreted by the machine learning algorithm, rendering the completion of thought records with the agent feasible. Participants chose interpersonal situations nearly three times as often as achievement-related situations in the open chat session. The three most common underlying schemas were the Attachment, Competence, and Global Self-evaluation schemas. No support was found for a motivational effect of providing richer feedback. In addition to our findings, we publish the dataset of thought records for interested researchers and developers.

Interactive Education on Sleep Hygiene with a Social Robot at a Pediatric Oncology Outpatient Clinic: Feasibility, Experiences, and Preliminary Effectiveness.

OBJECTIVES: Children with cancer often experience sleep problems, which are associated with many negative physical and psychological health outcomes, as well as with a lower quality of life. Therefore, interventions are strongly required to improve sleep in this population. We evaluated interactive education with respect to sleep hygiene with a social robot at a pediatric oncology outpatient clinic regarding the feasibility, experiences, and preliminary effectiveness. METHODS: Researchers approached children (8 to 12 years old) who were receiving anticancer treatment and who were visiting the outpatient clinic with their parents during the two-week study period. The researchers completed observation forms regarding feasibility, and parents completed the Children's Sleep Hygiene Scale before and two weeks after the educational regimen. The experiences of children and parents were evaluated in semi-structured interviews. We analyzed open answers by labeling each answer with a topic reflecting the content and collapsed these topics into categories. We used descriptive statistics to describe the feasibility and experiences, and a dependent-samples t-test to evaluate the preliminary effectiveness. RESULTS: Twenty-eight families participated (58% response rate) and all interactions with the robot were completed. The children and parents reported that they learned something new (75% and 50%, respectively), that they wanted to learn from the robot more often (83% and 75%, respectively), and that they applied the sleeping tips from the robot afterwards at home (54%). Regarding the preliminary effectiveness, children showed a statistically significant improvement in their sleep hygiene (p = 0.047, d = 0.39). CONCLUSIONS: Providing an educational regimen on sleep hygiene in a novel, interactive way by using a social robot at the outpatient clinic seemed feasible, and the children and parents mostly exhibited positive reactions. We found preliminary evidence that the sleep hygiene of children with cancer improved.

Users' needs for a digital smoking cessation application and how to address them: A mixed-methods study.

Background: Despite their increasing prevalence and potential, eHealth applications for behavior change suffer from a lack of adherence and from dropout. Advances in virtual coach technology provide new opportunities to improve this. However, these applications still do not always offer what people need. We, therefore, need a better understanding of people's needs and how to address these, based on both actual experiences of users and their reflections on envisioned scenarios. Methods: We conducted a longitudinal study in which 671 smokers interacted with a virtual coach in five sessions. The virtual coach assigned them a new preparatory activity for quitting smoking or increasing physical activity in each session. Participants provided feedback on the activity in the next session. After the five sessions, participants were asked to describe barriers and motivators for doing their activities. In addition, they provided their views on videos of scenarios such as receiving motivational messages. To understand users' needs, we took a mixed-methods approach. This approach triangulated findings from qualitative data, quantitative data, and the literature. Results: We identified 14 main themes that describe people's views of their current and future behaviors concerning an eHealth application. These themes relate to the behaviors themselves, the users, other parties involved in a behavior, and the environment. The most prevalent theme was the perceived usefulness of behaviors, especially whether they were informative, helpful, motivating, or encouraging. The timing and intensity of behaviors also mattered. With regards to the users, their perceived importance of and motivation to change, autonomy, and personal characteristics were major themes. Another important role was played by other parties that may be involved in a behavior, such as general practitioners or virtual coaches. Here, the themes of companionableness, accountability, and nature of the other party (i.e., human vs AI) were relevant. The last set of main themes was related to the environment in which a behavior is performed. Prevalent themes were the availability of sufficient time, the presence of prompts and triggers, support from one's social environment, and the diversity of other environmental factors. We provide recommendations for addressing each theme. Conclusions: The integrated method of experience-based and envisioning-based needs acquisition with a triangulate analysis provided a comprehensive needs classification (empirically and theoretically grounded). We expect that our themes and recommendations for addressing them will be helpful for designing applications for health behavior change that meet people's needs. Designers should especially focus on the perceived usefulness of application components. To aid future work, we publish our dataset with user characteristics and 5,074 free-text responses from 671 people.

Natural language processing for cognitive therapy: Extracting schemas from thought records.

The cognitive approach to psychotherapy aims to change patients' maladaptive schemas, that is, overly negative views on themselves, the world, or the future. To obtain awareness of these views, they record their thought processes in situations that caused pathogenic emotional responses. The schemas underlying such thought records have, thus far, been largely manually identified. Using recent advances in natural language processing, we take this one step further by automatically extracting schemas from thought records. To this end, we asked 320 healthy participants on Amazon Mechanical Turk to each complete five thought records consisting of several utterances reflecting cognitive processes. Agreement between two raters on manually scoring the utterances with respect to how much they reflect each schema was substantial (Cohen's κ = 0.79). Natural language processing software pretrained on all English Wikipedia articles from 2014 (GLoVE embeddings) was used to represent words and utterances, which were then mapped to schemas using k-nearest neighbors algorithms, support vector machines, and recurrent neural networks. For the more frequently occurring schemas, all algorithms were able to leverage linguistic patterns. For example, the scores assigned to the Competence schema by the algorithms correlated with the manually assigned scores with Spearman correlations ranging between 0.64 and 0.76. For six of the nine schemas, a set of recurrent neural networks trained separately for each of the schemas outperformed the other algorithms. We present our results here as a benchmark solution, since we conducted this research to explore the possibility of automatically processing qualitative mental health data and did not aim to achieve optimal performance with any of the explored models. The dataset of 1600 thought records comprising 5747 utterances is published together with this article for researchers and machine learning enthusiasts to improve upon our outcomes. Based on our promising results, we see further opportunities for using free-text input and subsequent natural language processing in other common therapeutic tools, such as ecological momentary assessments, automated case conceptualizations, and, more generally, as an alternative to mental health scales.

Identifying Interaction Patterns of Tangible Co-Adaptations in Human-Robot Team Behaviors.

As robots become more ubiquitous, they will increasingly need to behave as our team partners and smoothly adapt to the (adaptive) human team behaviors to establish successful patterns of collaboration over time. A substantial amount of adaptations present themselves through subtle and unconscious interactions, which are difficult to observe. Our research aims to bring about awareness of co-adaptation that enables team learning. This paper presents an experimental paradigm that uses a physical human-robot collaborative task environment to explore emergent human-robot co-adaptions and derive the interaction patterns (i.e., the targeted awareness of co-adaptation). The paradigm provides a tangible human-robot interaction (i.e., a leash) that facilitates the expression of unconscious adaptations, such as "leading" (e.g., pulling the leash) and "following" (e.g., letting go of the leash) in a search-and-navigation task. The task was executed by 18 participants, after which we systematically annotated videos of their behavior. We discovered that their interactions could be described by four types of adaptive interactions: stable situations, sudden adaptations, gradual adaptations and active negotiations. From these types of interactions we have created a language of interaction patterns that can be used to describe tacit co-adaptation in human-robot collaborative contexts. This language can be used to enable communication between collaborating humans and robots in future studies, to let them share what they learned and support them in becoming aware of their implicit adaptations.

Becoming Team Members: Identifying Interaction Patterns of Mutual Adaptation for Human-Robot Co-Learning.

Becoming a well-functioning team requires continuous collaborative learning by all team members. This is called co-learning, conceptualized in this paper as comprising two alternating iterative stages: partners adapting their behavior to the task and to each other (co-adaptation), and partners sustaining successful behavior through communication. This paper focuses on the first stage in human-robot teams, aiming at a method for the identification of recurring behaviors that indicate co-learning. Studying this requires a task context that allows for behavioral adaptation to emerge from the interactions between human and robot. We address the requirements for conducting research into co-adaptation by a human-robot team, and designed a simplified computer simulation of an urban search and rescue task accordingly. A human participant and a virtual robot were instructed to discover how to collaboratively free victims from the rubbles of an earthquake. The virtual robot was designed to be able to real-time learn which actions best contributed to good team performance. The interactions between human participants and robots were recorded. The observations revealed patterns of interaction used by human and robot in order to adapt their behavior to the task and to one another. Results therefore show that our task environment enables us to study co-learning, and suggest that more participant adaptation improved robot learning and thus team level learning. The identified interaction patterns can emerge in similar task contexts, forming a first description and analysis method for co-learning. Moreover, the identification of interaction patterns support awareness among team members, providing the foundation for human-robot communication about the co-adaptation (i.e., the second stage of co-learning). Future research will focus on these human-robot communication processes for co-learning.

Quality of Care Perceived by Older Patients and Caregivers in Integrated Care Pathways With Interviewing Assistance From a Social Robot: Noninferiority Randomized Controlled Trial.

BACKGROUND: Society is facing a global shortage of 17 million health care workers, along with increasing health care demands from a growing number of older adults. Social robots are being considered as solutions to part of this problem. OBJECTIVE: Our objective is to evaluate the quality of care perceived by patients and caregivers for an integrated care pathway in an outpatient clinic using a social robot for patient-reported outcome measure (PROM) interviews versus the currently used professional interviews. METHODS: A multicenter, two-parallel-group, nonblinded, randomized controlled trial was used to test for noninferiority of the quality of care delivered through robot-assisted care. The randomization was performed using a computer-generated table. The setting consisted of two outpatient clinics, and the study took place from July to December 2019. Of 419 patients who visited the participating outpatient clinics, 110 older patients met the criteria for recruitment. Inclusion criteria were the ability to speak and read Dutch and being assisted by a participating health care professional. Exclusion criteria were serious hearing or vision problems, serious cognitive problems, and paranoia or similar psychiatric problems. The intervention consisted of a social robot conducting a 36-item PROM. As the main outcome measure, the customized Consumer Quality Index (CQI) was used, as reported by patients and caregivers for the outpatient pathway of care. RESULTS: In total, 75 intermediately frail older patients were included in the study, randomly assigned to the intervention and control groups, and processed: 36 female (48%) and 39 male (52%); mean age 77.4 years (SD 7.3), range 60-91 years. There was no significant difference in the total patient CQI scores between the patients included in the robot-assisted care pathway (mean 9.27, SD 0.65, n=37) and those in the control group (mean 9.00, SD 0.70, n=38): P=.08, 95% CI -0.04 to 0.58. There was no significant difference in the total CQI scores between caregivers in the intervention group (mean 9.21, SD 0.76, n=30) and those in the control group (mean 9.09, SD 0.60, n=35): P=.47, 95% CI -0.21 to 0.46. No harm or unintended effects occurred. CONCLUSIONS: Geriatric patients and their informal caregivers valued robot-assisted and nonrobot-assisted care pathways equally. TRIAL REGISTRATION: ClinicalTrials.gov NCT03857789; https://clinicaltrials.gov/ct2/show/NCT03857789.

Technological State of the Art of Electronic Mental Health Interventions for Major Depressive Disorder: Systematic Literature Review.

BACKGROUND: Electronic mental (e-mental) health care for depression aims to overcome barriers to and limitations of face-to-face treatment. Owing to the high and growing demand for mental health care, a large number of such information and communication technology systems have been developed in recent years. Consequently, a diverse system landscape formed. OBJECTIVE: This literature review aims to give an overview of this landscape of e-mental health systems for the prevention and treatment of major depressive disorder, focusing on three main research questions: (1) What types of systems exist? (2) How technologically advanced are these systems? (3) How has the system landscape evolved between 2000 and 2017? METHODS: Publications eligible for inclusion described e-mental health software for the prevention or treatment of major depressive disorder. Additionally, the software had to have been evaluated with end users and developed since 2000. After screening, 270 records remained for inclusion. We constructed a taxonomy concerning software systems, their functions, how technologized these were in their realization, and how systems were evaluated, and then, we extracted this information from the included records. We define here as functions any component of the system that delivers either treatment or adherence support to the user. For this coding process, an elaborate classification hierarchy for functions was developed yielding a total of 133 systems with 2163 functions. The systems and their functions were analyzed quantitatively, with a focus on technological realization. RESULTS: There are various types of systems. However, most are delivered on the World Wide Web (76%), and most implement cognitive behavioral therapy techniques (85%). In terms of content, systems contain twice as many treatment functions as adherence support functions, on average. Furthermore, autonomous systems, those not including human guidance, are equally as technologized and have one-third less functions than guided ones. Therefore, lack of guidance is neither compensated with additional functions nor compensated by technologizing functions to a greater degree. Although several high-tech solutions could be found, the average system falls between a purely informational system and one that allows for data entry but without automatically processing these data. Moreover, no clear increase in the technological capabilities of systems showed in the field, between 2000 and 2017, despite a marked growth in system quantity. Finally, more sophisticated systems were evaluated less often in comparative trials than less sophisticated ones (OR 0.59). CONCLUSIONS: The findings indicate that when developers create systems, there is a greater focus on implementing therapeutic treatment than adherence support. Although the field is very active, as evidenced by the growing number of systems developed per year, the technological possibilities explored are limited. In addition to allowing developers to compare their system with others, we anticipate that this review will help researchers identify opportunities in the field.

Correction: Controlling Social Stress in Virtual Reality Environments.

[This corrects the article DOI: 10.1371/journal.pone.0092804.].

Robot for health data acquisition among older adults: a pilot randomised controlled cross-over trial.

BACKGROUND /OBJECTIVES: Healthcare professionals (HCP) are confronted with an increased demand for assessments of important health status measures, such as patient-reported outcome measurements (PROM), and the time this requires. The aim of this study was to investigate the effectiveness and acceptability of using an HCP robot assistant, and to test the hypothesis that a robot can autonomously acquire PROM data from older adults. DESIGN: A pilot randomised controlled cross-over study where a social robot and a nurse administered three PROM questionnaires with a total of 52 questions. SETTING: A clinical outpatient setting with community-dwelling older adults. PARTICIPANTS: Forty-two community-dwelling older adults (mean age: 77.1 years, SD: 5.7 years, 45% female). MEASUREMENTS: The primary outcome was the task time required for robot-patient and nurse-patient interactions. Secondary outcomes were the similarity of the data and the percentage of robot interactions completed autonomously. The questionnaires resulted in two values (robot and nurse) for three indexes of frailty, well-being and resilience. The data similarity was determined by comparing these index values using Bland-Altman plots, Cohen's kappa (κ) and intraclass correlation coefficients (ICC). Acceptability was assessed using questionnaires. RESULTS: The mean robot interview duration was 16.57 min (SD=1.53 min), which was not significantly longer than the nurse interviews (14.92 min, SD=8.47 min; p=0.19). The three Bland-Altman plots showed moderate to substantial agreement between the frailty, well-being and resilience scores (κ=0.61, 0.50 and 0.45, and ICC=0.79, 0.86 and 0.66, respectively). The robot autonomously completed 39 of 42 interviews (92.8%). CONCLUSION: Social robots may effectively and acceptably assist HCPs by interviewing older adults.

Considering patient safety in autonomous e-mental health systems - detecting risk situations and referring patients back to human care.

BACKGROUND: Digital health interventions can fill gaps in mental healthcare provision. However, autonomous e-mental health (AEMH) systems also present challenges for effective risk management. To balance autonomy and safety, AEMH systems need to detect risk situations and act on these appropriately. One option is sending automatic alerts to carers, but such 'auto-referral' could lead to missed cases or false alerts. Requiring users to actively self-refer offers an alternative, but this can also be risky as it relies on their motivation to do so. This study set out with two objectives. Firstly, to develop guidelines for risk detection and auto-referral systems. Secondly, to understand how persuasive techniques, mediated by a virtual agent, can facilitate self-referral. METHODS: In a formative phase, interviews with experts, alongside a literature review, were used to develop a risk detection protocol. Two referral protocols were developed - one involving auto-referral, the other motivating users to self-refer. This latter was tested via crowd-sourcing (n = 160). Participants were asked to imagine they had sleeping problems with differing severity and user stance on seeking help. They then chatted with a virtual agent, who either directly facilitated referral, tried to persuade the user, or accepted that they did not want help. After the conversation, participants rated their intention to self-refer, to chat with the agent again, and their feeling of being heard by the agent. RESULTS: Whether the virtual agent facilitated, persuaded or accepted, influenced all of these measures. Users who were initially negative or doubtful about self-referral could be persuaded. For users who were initially positive about seeking human care, this persuasion did not affect their intentions, indicating that a simply facilitating referral without persuasion was sufficient. CONCLUSION: This paper presents a protocol that elucidates the steps and decisions involved in risk detection, something that is relevant for all types of AEMH systems. In the case of self-referral, our study shows that a virtual agent can increase users' intention to self-refer. Moreover, the strategy of the agent influenced the intentions of the user afterwards. This highlights the importance of a personalised approach to promote the user's access to appropriate care.

Design and Evaluation of Personalized Motivational Messages by a Virtual Agent that Assists in Post-Traumatic Stress Disorder Therapy.

BACKGROUND: Systems incorporating virtual agents can play a major role in electronic-mental (e-mental) health care, as barriers to care still prevent some patients from receiving the help they need. To properly assist the users of these systems, a virtual agent needs to promote motivation. This can be done by offering motivational messages. OBJECTIVE: The objective of this study was two-fold. The first was to build a motivational message system for a virtual agent assisting in post-traumatic stress disorder (PTSD) therapy based on domain knowledge from experts. The second was to test the hypotheses that (1) computer-generated motivating messages influence users' motivation to continue with therapy, trust in a good therapy outcome, and the feeling of being heard by the agent and (2) personalized messages outperform generic messages on these factors. METHODS: A system capable of generating motivational messages was built by analyzing expert (N=13) knowledge on what types of motivational statements to use in what situation. To test the 2 hypotheses, a Web-based study was performed (N=207). Participants were asked to imagine they were in a certain situation, specified by the progression of their symptoms and initial trust in a good therapy outcome. After this, they received a message from a virtual agent containing either personalized motivation as generated by the system, general motivation, or no motivational content. They were asked how this message changed their motivation to continue and trust in a good outcome as well as how much they felt they were being heard by the agent. RESULTS: Overall, findings confirmed the first hypothesis, as well as the second hypothesis for the measure feeling of being heard by the agent. Personalization of the messages was also shown to be important in those situations where the symptoms were getting worse. In these situations, personalized messages outperformed general messages both in terms of motivation to continue and trust in a good therapy outcome. CONCLUSIONS: Expert input can successfully be used to develop a personalized motivational message system. Messages generated by such a system seem to improve people's motivation and trust in PTSD therapy as well as the user's feeling of being heard by a virtual agent. Given the importance of motivation, trust, and therapeutic alliance for successful therapy, we anticipate that the proposed system can improve adherence in e-mental therapy for PTSD and that it can provide a blueprint for the development of an adaptive system for persuasive messages based on expert input.

Socio-Cognitive Engineering of a Robotic Partner for Child's Diabetes Self-Management.

Social or humanoid robots do hardly show up in "the wild," aiming at pervasive and enduring human benefits such as child health. This paper presents a socio-cognitive engineering (SCE) methodology that guides the ongoing research & development for an evolving, longer-lasting human-robot partnership in practice. The SCE methodology has been applied in a large European project to develop a robotic partner that supports the daily diabetes management processes of children, aged between 7 and 14 years (i.e., Personal Assistant for a healthy Lifestyle, PAL). Four partnership functions were identified and worked out (joint objectives, agreements, experience sharing, and feedback & explanation) together with a common knowledge-base and interaction design for child's prolonged disease self-management. In an iterative refinement process of three cycles, these functions, knowledge base and interactions were built, integrated, tested, refined, and extended so that the PAL robot could more and more act as an effective partner for diabetes management. The SCE methodology helped to integrate into the human-agent/robot system: (a) theories, models, and methods from different scientific disciplines, (b) technologies from different fields, (c) varying diabetes management practices, and (d) last but not least, the diverse individual and context-dependent needs of the patients and caregivers. The resulting robotic partner proved to support the children on the three basic needs of the Self-Determination Theory: autonomy, competence, and relatedness. This paper presents the R&D methodology and the human-robot partnership framework for prolonged "blended" care of children with a chronic disease (children could use it up to 6 months; the robot in the hospitals and diabetes camps, and its avatar at home). It represents a new type of human-agent/robot systems with an evolving collective intelligence. The underlying ontology and design rationale can be used as foundation for further developments of long-duration human-robot partnerships "in the wild."

Friendship with a robot: Children's perception of similarity between a robot's physical and virtual embodiment that supports diabetes self-management.

OBJECTIVE: The PAL project develops a conversational agent with a physical (robot) and virtual (avatar) embodiment to support diabetes self-management of children ubiquitously. This paper assesses 1) the effect of perceived similarity between robot and avatar on children's' friendship towards the avatar, and 2) the effect of this friendship on usability of a self-management application containing the avatar (a) and children's motivation to play with it (b). METHODS: During a four-day diabetes camp in the Netherlands, 21 children participated in interactions with both agent embodiments. Questionnaires measured perceived similarity, friendship, motivation to play with the app and its usability. RESULTS: Children felt stronger friendship towards the physical robot than towards the avatar. The more children perceived the robot and its avatar as the same agency, the stronger their friendship with the avatar was. The stronger their friendship with the avatar, the more they were motivated to play with the app and the higher the app scored on usability. CONCLUSION: The combination of physical and virtual embodiments seems to provide a unique opportunity for building ubiquitous long-term child-agent friendships. PRACTICE IMPLICATIONS: an avatar complementing a physical robot in health care could increase children's motivation and adherence to use self-management support systems.

Reminders make people adhere better to a self-help sleep intervention.

The experiment presented in this paper investigated the effects of different kinds of reminders on adherence to automated parts of a cognitive behavioural therapy for insomnia (CBT-I) delivered via a mobile device. Previous studies report that computerized health interventions can be effective. However, treatment adherence is still an issue. Reminders are a simple technique that could improve adherence. A minimal intervention prototype in the realm of sleep treatment was developed to test the effects of reminders on adherence. Two prominent ways to determine the reminder-time are: a) ask users when they want to be reminded, and b) let an algorithm decide when to remind users. The prototype consisted of a sleep diary, a relaxation exercise and reminders. A within subject design was used in which the effect of reminders and two underlying principles were tested by 45 participants that all received the following three different conditions (in random order): a) event-based reminders b) time-based reminders c) no reminders. Both types of reminders improved adherence compared to no reminders. No differences were found between the two types of reminders. Opportunity and self-empowerment could partly mediate adherence to filling out the sleep diary, but not to the number of relaxation exercises conducted. Although the study focussed on CBT-I, we expect that designers of other computerized health interventions benefit from the tested opportunity and self-empowerment principles for reminders to improve adherence, as well.