Chatbots to Support Mental Wellbeing of People Living in Rural Areas: Can User Groups Contribute to Co-design?

Digital technologies such as chatbots can be used in the field of mental health. In particular, chatbots can be used to support citizens living in sparsely populated areas who face problems such as poor access to mental health services, lack of 24/7 support, barriers to engagement, lack of age appropriate support and reductions in health budgets. The aim of this study was to establish if user groups can design content for a chatbot to support the mental wellbeing of individuals in rural areas. University students and staff, mental health professionals and mental health service users (N = 78 total) were recruited to workshops across Northern Ireland, Ireland, Scotland, Finland and Sweden. The findings revealed that participants wanted a positive chatbot that was able to listen, support, inform and build a rapport with users. Gamification could be used within the chatbot to increase user engagement and retention. Content within the chatbot could include validated mental health scales and appropriate response triggers, such as signposting to external resources should the user disclose potentially harmful information or suicidal intent. Overall, the workshop participants identified user needs which can be transformed into chatbot requirements. Responsible design of mental healthcare chatbots should consider what users want or need, but also what chatbot features artificial intelligence can competently facilitate and which features mental health professionals would endorse.

A pilot program to evaluate pain assessment skills of hospice nurses.

A program was developed to evaluate pain assessment skills of hospice nurses in the home setting, utilizing standardized patients (SPs). Hospice nurses were sent on a routine visit to a "patient's" home to evaluate someone dying of pancreatic cancer. They were not informed in advance that the "patient" was actually an SP, who had undergone intensive training from the staff to prepare him for his role. They performed their usual evaluation and then reported back to the referring physician by telephone. The referring physician, who used a written series of evaluation criteria, graded their assessments. The SP also evaluated the assessment skills of each nurse. After the exercise, the nurses were informed of the "patient's" identity and were provided with the written critique prepared by the SP. A second part of the program included a written examination of their pain assessment and treatment skills, followed by a didactic presentation. This is the first report we know of that has utilized SPs in the home setting to evaluate pain assessment skills in a blind fashion. Our findings indicate that this can be an effective method for measuring pain assessment skills as well as a valuable teaching device.

The effect of simulating on standardized patients.

BACKGROUND: With the growing use of standardized patients (SPs) in medical teaching and evaluation, a new occupation has emerged-that of SP. METHOD: The effect of simulating was discussed in five focus groups with randomly chosen SPs from the SP program at the McMaster University Faculty of Health Sciences in 1993. Meeting transcripts were content analyzed and reviewed by the SPs to ensure that the data were trustworthy. RESULTS: Of the SPs invited to attend a focus group, 37 of 59 (63%) attended. The SPs stated that their role is complex and requires improvising while simultaneously monitoring the learner's performance to later provide detailed feedback. The SPs reported that they developed a more balanced view of health professionals, developed better communication skills, and became more tolerant of others. The role allowed them to explore how they reacted in novel situations, which enabled them to learn more about themselves. CONCLUSION: The SPs described numerous effects of the SP role on their lives. Greater attention should be paid to how SPs are selected and debriefed.

Measuring physicians' performances by using simulated patients.

The authors in this paper discuss a new approach to the assessment of physicians' performances in practice using undetected standardized (simulated) patients. Case-specific performance criteria were established for seven standardized patients by eight family physicians and two specialists. The patients were then introduced into the practices of the family physicians and of a second cohort of seven family physicians. No differences were found between the criteria-setting and the noncriteria-setting physicians; but large differences were found among the criteria, the physicians' performances as indicated by the patient, and the data recorded by the physicians on the patient chart. Depending on the method used to score the performance and the recorded data, about 30 to 45 percent of the procedures were not performed, and 50 to 70 percent of the criteria were not recorded. The implications of the study for assessment of physician performance are discussed.

Measurement of physician performance by standardized patients. Refining techniques for undetected entry in physicians' offices.

The article describes the development of methods to use live simulated patients for assessment of quality of care of primary physicians. Methods used to train patients and achieve undetected entry into physicians' practices are described. The study demonstrated that patients can be entered into practices with a low rate of detection (13%) and that they are able to recall the details of the encounter with a high degree of reliability.