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Published in: Journal of Medical Systems 1/2023

01-12-2023 | Original Paper

Development and Validation of Conversational Agent to Pregnancy Safe-education

Authors: João Luis Zeni Montenegro, Cristiano André da Costa, Rodrigo da Rosa Righi, Elson Romeu Farias, Lara Balen Matté

Published in: Journal of Medical Systems | Issue 1/2023

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Abstract

Pregnant women constantly need some information to support nutritional decisions during pregnancy, and many do not receive such assistance at all. This study aims to present a conversational agent to provide reliable information to pregnant women, focusing on nutritional education and evaluating the perception of pregnant women and health professionals about the agent. As a scientific contribution, this article developed and implemented a conversational agent in a real environment capable of generating reliable responses on the basis of a set of health documents. We proposed an intervention study with 25 women and 10 healthcare providers through a survey to measure the perceptions of these groups towards conversational agents. The results show that the intended design could ensure positive support for pregnant women, clarify certain issues for the public, and remove some knowledge barriers. The results showed no significant difference between the groups (p-value = 0.713). Depending on the perception of the pregnant group, the conversational agent model can teach new knowledge during the prenatal period (Mean = 4.56). The model presented for health professionals could already be indicated as a support tool for pregnant women (Mean = 4.7).
Literature
1.
go back to reference Grolleman, J., van Dijk, B., Nijholt, A., van Emst, A.: Break the habit! designing an e-therapy intervention using a virtual coach in aid of smoking cessation. In: Persuasive Technology, pp. 133–141. Springer (2006) Grolleman, J., van Dijk, B., Nijholt, A., van Emst, A.: Break the habit! designing an e-therapy intervention using a virtual coach in aid of smoking cessation. In: Persuasive Technology, pp. 133–141. Springer (2006)
3.
go back to reference Edwards, R.A., Bickmore, T., Jenkins, L., Foley, M., Manjourides, J.: Use of an interactive computer agent to support breastfeeding. Maternal and child health journal 17(10), 1961–1968 (2013)CrossRefPubMed Edwards, R.A., Bickmore, T., Jenkins, L., Foley, M., Manjourides, J.: Use of an interactive computer agent to support breastfeeding. Maternal and child health journal 17(10), 1961–1968 (2013)CrossRefPubMed
4.
go back to reference Fadhil, A., Gabrielli, S.: Addressing challenges in promoting healthy lifestyles: the al-chatbot approach. In: Proceedings of the 11th EAI International Conference on Pervasive Computing Technologies for Healthcare, pp. 261–265. ACM (2017) Fadhil, A., Gabrielli, S.: Addressing challenges in promoting healthy lifestyles: the al-chatbot approach. In: Proceedings of the 11th EAI International Conference on Pervasive Computing Technologies for Healthcare, pp. 261–265. ACM (2017)
5.
go back to reference Pereira, J., Díaz, Ó.: Using health chatbots for behavior change: a mapping study. Journal of medical systems 43(5), 135 (2019)CrossRefPubMed Pereira, J., Díaz, Ó.: Using health chatbots for behavior change: a mapping study. Journal of medical systems 43(5), 135 (2019)CrossRefPubMed
6.
go back to reference Martínez-Miranda, J.: Embodied conversational agents for the detection and prevention of suicidal behaviour: current applications and open challenges. Journal of medical systems 41(9), 135 (2017)CrossRefPubMed Martínez-Miranda, J.: Embodied conversational agents for the detection and prevention of suicidal behaviour: current applications and open challenges. Journal of medical systems 41(9), 135 (2017)CrossRefPubMed
7.
go back to reference de Rosis, F., Novielli, N., Carofiglio, V., Cavalluzzi, A., De Carolis, B.: User modeling and adaptation in health promotion dialogs with an animated character. Journal of biomedical informatics 39(5), 514–531 (2006)CrossRefPubMed de Rosis, F., Novielli, N., Carofiglio, V., Cavalluzzi, A., De Carolis, B.: User modeling and adaptation in health promotion dialogs with an animated character. Journal of biomedical informatics 39(5), 514–531 (2006)CrossRefPubMed
8.
go back to reference Amith, M., Roberts, K., Tao, C.: Conceiving an application ontology to model patient human papillomavirus vaccine counseling for dialogue management. BMC bioinformatics 20(21), 1–16 (2019) Amith, M., Roberts, K., Tao, C.: Conceiving an application ontology to model patient human papillomavirus vaccine counseling for dialogue management. BMC bioinformatics 20(21), 1–16 (2019)
9.
go back to reference Fadhil, A., Wang, Y., Reiterer, H.: Assistive conversational agent for health coaching: a validation study. Methods of information in medicine 58(01), 009–023 (2019)CrossRef Fadhil, A., Wang, Y., Reiterer, H.: Assistive conversational agent for health coaching: a validation study. Methods of information in medicine 58(01), 009–023 (2019)CrossRef
10.
go back to reference Auriacombe, M., Moriceau, S., Serre, F., Denis, C., Micoulaud-Franchi, J.A., de Sevin, E., Bonhomme, E., Bioulac, S., Fatseas, M., Philip, P.: Development and validation of a virtual agent to screen tobacco and alcohol use disorders. Drug and alcohol dependence 193, 1–6 (2018)CrossRefPubMed Auriacombe, M., Moriceau, S., Serre, F., Denis, C., Micoulaud-Franchi, J.A., de Sevin, E., Bonhomme, E., Bioulac, S., Fatseas, M., Philip, P.: Development and validation of a virtual agent to screen tobacco and alcohol use disorders. Drug and alcohol dependence 193, 1–6 (2018)CrossRefPubMed
11.
go back to reference Collins, S.A., Currie, L.M., Bakken, S., Vawdrey, D.K., Stone, P.W.: Health literacy screening instruments for ehealth applications: a systematic review. Journal of biomedical informatics 45(3), 598–607 (2012)CrossRefPubMedPubMedCentral Collins, S.A., Currie, L.M., Bakken, S., Vawdrey, D.K., Stone, P.W.: Health literacy screening instruments for ehealth applications: a systematic review. Journal of biomedical informatics 45(3), 598–607 (2012)CrossRefPubMedPubMedCentral
12.
go back to reference Nouri, S.S., Rudd, R.E.: Health literacy in the “oral exchange”: An important element of patient–provider communication. Patient education and counseling 98(5), 565–571 (2015)CrossRefPubMed Nouri, S.S., Rudd, R.E.: Health literacy in the “oral exchange”: An important element of patient–provider communication. Patient education and counseling 98(5), 565–571 (2015)CrossRefPubMed
13.
go back to reference Bickmore, T.W., Pfeifer, L.M., Jack, B.W.: Taking the time to care: empowering low health literacy hospital patients with virtual nurse agents. In: Proceedings of the SIGCHI conference on human factors in computing systems, pp. 1265–1274. ACM (2009) Bickmore, T.W., Pfeifer, L.M., Jack, B.W.: Taking the time to care: empowering low health literacy hospital patients with virtual nurse agents. In: Proceedings of the SIGCHI conference on human factors in computing systems, pp. 1265–1274. ACM (2009)
14.
go back to reference Bickmore, T.W., Pfeifer, L.M., Byron, D., Forsythe, S., Henault, L.E., Jack, B.W., Silliman, R., Paasche-Orlow, M.K.: Usability of conversational agents by patients with inadequate health literacy: evidence from two clinical trials. Journal of health communication 15(S2), 197–210 (2010)CrossRefPubMed Bickmore, T.W., Pfeifer, L.M., Byron, D., Forsythe, S., Henault, L.E., Jack, B.W., Silliman, R., Paasche-Orlow, M.K.: Usability of conversational agents by patients with inadequate health literacy: evidence from two clinical trials. Journal of health communication 15(S2), 197–210 (2010)CrossRefPubMed
15.
go back to reference Keene Woods, N., Chesser, A.K.: Validation of a single question health literacy screening tool for older adults. Gerontology and Geriatric Medicine 3, 2333721417713095 (2017)CrossRefPubMedPubMedCentral Keene Woods, N., Chesser, A.K.: Validation of a single question health literacy screening tool for older adults. Gerontology and Geriatric Medicine 3, 2333721417713095 (2017)CrossRefPubMedPubMedCentral
16.
go back to reference Jack, B., Bickmore, T., Hempstead, M., Yinusa-Nyahkoon, L., Sadikova, E., Mitchell, S., Gardiner, P., Adigun, F., Penti, B., Schulman, D., et al.: Reducing preconception risks among african american women with conversational agent technology. The Journal of the American Board of Family Medicine 28(4), 441–451 (2015)CrossRefPubMed Jack, B., Bickmore, T., Hempstead, M., Yinusa-Nyahkoon, L., Sadikova, E., Mitchell, S., Gardiner, P., Adigun, F., Penti, B., Schulman, D., et al.: Reducing preconception risks among african american women with conversational agent technology. The Journal of the American Board of Family Medicine 28(4), 441–451 (2015)CrossRefPubMed
17.
go back to reference Zhang, Z., Bickmore, T., Mainello, K., Mueller, M., Foley, M., Jenkins, L., Edwards, R.A.: Maintaining continuity in longitudinal, multi-method health interventions using virtual agents: the case of breastfeeding promotion. In: International Conference on Intelligent Virtual Agents, pp. 504–513. Springer (2014) Zhang, Z., Bickmore, T., Mainello, K., Mueller, M., Foley, M., Jenkins, L., Edwards, R.A.: Maintaining continuity in longitudinal, multi-method health interventions using virtual agents: the case of breastfeeding promotion. In: International Conference on Intelligent Virtual Agents, pp. 504–513. Springer (2014)
18.
go back to reference Tanana, M.J., Soma, C.S., Srikumar, V., Atkins, D.C., Imel, Z.E.: Development and evaluation of clientbot: Patient-like conversational agent to train basic counseling skills. Journal of medical Internet research 21(7), e12529 (2019)CrossRefPubMedPubMedCentral Tanana, M.J., Soma, C.S., Srikumar, V., Atkins, D.C., Imel, Z.E.: Development and evaluation of clientbot: Patient-like conversational agent to train basic counseling skills. Journal of medical Internet research 21(7), e12529 (2019)CrossRefPubMedPubMedCentral
19.
go back to reference Mikolov, T., Sutskever, I., Chen, K., Corrado, G.S., Dean, J.: Distributed representations of words and phrases and their compositionality. In: Advances in neural information processing systems, pp. 3111–3119 (2013) Mikolov, T., Sutskever, I., Chen, K., Corrado, G.S., Dean, J.: Distributed representations of words and phrases and their compositionality. In: Advances in neural information processing systems, pp. 3111–3119 (2013)
20.
go back to reference Wang, S., Gittens, A., Mahoney, M.W.: Scalable kernel k-means clustering with nyström approximation: relative-error bounds. The Journal of Machine Learning Research 20(1), 431–479 (2019) Wang, S., Gittens, A., Mahoney, M.W.: Scalable kernel k-means clustering with nyström approximation: relative-error bounds. The Journal of Machine Learning Research 20(1), 431–479 (2019)
21.
go back to reference Gomaa, W.H., Fahmy, A.A., et al.: A survey of text similarity approaches. International Journal of Computer Applications 68(13), 13–18 (2013)CrossRef Gomaa, W.H., Fahmy, A.A., et al.: A survey of text similarity approaches. International Journal of Computer Applications 68(13), 13–18 (2013)CrossRef
22.
go back to reference Sijpkens, M.K., van Voorst, S.F., de Jong-Potjer, L.C., Denktaş, S., Verhoeff, A.P., Bertens, L.C., Rosman, A.N., Steegers, E.A.: The effect of a preconception care outreach strategy: the healthy pregnancy 4 all study. BMC health services research 19(1), 60 (2019)CrossRefPubMedPubMedCentral Sijpkens, M.K., van Voorst, S.F., de Jong-Potjer, L.C., Denktaş, S., Verhoeff, A.P., Bertens, L.C., Rosman, A.N., Steegers, E.A.: The effect of a preconception care outreach strategy: the healthy pregnancy 4 all study. BMC health services research 19(1), 60 (2019)CrossRefPubMedPubMedCentral
23.
go back to reference Yadav, D., Malik, P., Dabas, K., Singh, P.: Feedpal: Understanding opportunities for chatbots in breastfeeding education of women in india. Proceedings of the ACM on Human-Computer Interaction 3(CSCW), 1–30 (2019) Yadav, D., Malik, P., Dabas, K., Singh, P.: Feedpal: Understanding opportunities for chatbots in breastfeeding education of women in india. Proceedings of the ACM on Human-Computer Interaction 3(CSCW), 1–30 (2019)
24.
go back to reference Montanaro, C., Lacey, L., Robson, L., Estill, A., Vukovic, S.: Preconception care: A technology-based model for delivery in the primary care setting supported by public health. Maternal and child health journal 23(12), 1581–1586 (2019)CrossRefPubMed Montanaro, C., Lacey, L., Robson, L., Estill, A., Vukovic, S.: Preconception care: A technology-based model for delivery in the primary care setting supported by public health. Maternal and child health journal 23(12), 1581–1586 (2019)CrossRefPubMed
25.
go back to reference Shorey, S., Ang, E., Yap, J., Ng, E.D., Lau, S.T., Chui, C.K.: A virtual counseling application using artificial intelligence for communication skills training in nursing education: development study. Journal of medical Internet research 21(10), e14658 (2019)CrossRefPubMedPubMedCentral Shorey, S., Ang, E., Yap, J., Ng, E.D., Lau, S.T., Chui, C.K.: A virtual counseling application using artificial intelligence for communication skills training in nursing education: development study. Journal of medical Internet research 21(10), e14658 (2019)CrossRefPubMedPubMedCentral
26.
go back to reference Vaira, L., Bochicchio, M.A., Conte, M., Casaluci, F.M., Melpignano, A.: Mamabot: a system based on ml and nlp for supporting women and families during pregnancy. In: Proceedings of the 22nd International Database Engineering & Applications Symposium, pp. 273–277. ACM (2018) Vaira, L., Bochicchio, M.A., Conte, M., Casaluci, F.M., Melpignano, A.: Mamabot: a system based on ml and nlp for supporting women and families during pregnancy. In: Proceedings of the 22nd International Database Engineering & Applications Symposium, pp. 273–277. ACM (2018)
27.
go back to reference Patel, S.J., Subbiah, S., Jones, R., Muigai, F., Rothschild, C.W., Omwodo, L., Ogolla, T., Kimenju, G., Pearson, N., Meadows, A., et al.: Providing support to pregnant women and new mothers through moderated whatsapp groups: a feasibility study. mHealth 4(5) (2018) Patel, S.J., Subbiah, S., Jones, R., Muigai, F., Rothschild, C.W., Omwodo, L., Ogolla, T., Kimenju, G., Pearson, N., Meadows, A., et al.: Providing support to pregnant women and new mothers through moderated whatsapp groups: a feasibility study. mHealth 4(5) (2018)
28.
go back to reference Cohn, M., Chen, C.Y., Yu, Z.: A large-scale user study of an alexa prize chatbot: Effect of tts dynamism on perceived quality of social dialog. In: Proceedings of the 20th Annual SIGdial Meeting on Discourse and Dialogue, pp. 293–306 (2019) Cohn, M., Chen, C.Y., Yu, Z.: A large-scale user study of an alexa prize chatbot: Effect of tts dynamism on perceived quality of social dialog. In: Proceedings of the 20th Annual SIGdial Meeting on Discourse and Dialogue, pp. 293–306 (2019)
29.
go back to reference Hemsing, N., Greaves, L., Poole, N.: Preconception health care interventions: a scoping review. Sexual & reproductive healthcare 14, 24–32 (2017)CrossRef Hemsing, N., Greaves, L., Poole, N.: Preconception health care interventions: a scoping review. Sexual & reproductive healthcare 14, 24–32 (2017)CrossRef
30.
go back to reference Peng, Z., Guo, Q., Tsang, K.W., Ma, X.: Exploring the effects of technological writing assistance for support providers in online mental health community. In: Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems, pp. 1–15 (2020) Peng, Z., Guo, Q., Tsang, K.W., Ma, X.: Exploring the effects of technological writing assistance for support providers in online mental health community. In: Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems, pp. 1–15 (2020)
31.
go back to reference Simms, L.J., Zelazny, K., Williams, T.F., Bernstein, L.: Does the number of response options matter? psychometric perspectives using personality questionnaire data. Psychological assessment 31(4), 557 (2019)CrossRefPubMed Simms, L.J., Zelazny, K., Williams, T.F., Bernstein, L.: Does the number of response options matter? psychometric perspectives using personality questionnaire data. Psychological assessment 31(4), 557 (2019)CrossRefPubMed
33.
34.
go back to reference Massey Jr, F.J.: The kolmogorov-smirnov test for goodness of fit. Journal of the American statistical Association 46(253), 68–78 (1951)CrossRef Massey Jr, F.J.: The kolmogorov-smirnov test for goodness of fit. Journal of the American statistical Association 46(253), 68–78 (1951)CrossRef
35.
go back to reference Sayakhot, P., Carolan-Olah, M.: Internet use by pregnant women seeking pregnancy-related information: a systematic review. BMC pregnancy and childbirth 16(1), 65 (2016)CrossRefPubMedPubMedCentral Sayakhot, P., Carolan-Olah, M.: Internet use by pregnant women seeking pregnancy-related information: a systematic review. BMC pregnancy and childbirth 16(1), 65 (2016)CrossRefPubMedPubMedCentral
36.
go back to reference Murakami, K., Miyake, Y., Sasaki, S., Tanaka, K., Ohya, Y., Hirota, Y., et al.: Education, but not occupation or household income, is positively related to favorable dietary intake patterns in pregnant japanese women: the osaka maternal and child health study. Nutrition Research 29(3), 164–172 (2009)CrossRefPubMed Murakami, K., Miyake, Y., Sasaki, S., Tanaka, K., Ohya, Y., Hirota, Y., et al.: Education, but not occupation or household income, is positively related to favorable dietary intake patterns in pregnant japanese women: the osaka maternal and child health study. Nutrition Research 29(3), 164–172 (2009)CrossRefPubMed
37.
go back to reference Gardiner, P., Hempstead, M.B., Ring, L., Bickmore, T., Yinusa-Nyahkoon, L., Tran, H., Paasche-Orlow, M., Damus, K., Jack, B.: Reaching women through health information technology: the gabby preconception care system. American Journal of Health Promotion 27(3_suppl), eS11–eS20 (2013) Gardiner, P., Hempstead, M.B., Ring, L., Bickmore, T., Yinusa-Nyahkoon, L., Tran, H., Paasche-Orlow, M., Damus, K., Jack, B.: Reaching women through health information technology: the gabby preconception care system. American Journal of Health Promotion 27(3_suppl), eS11–eS20 (2013)
38.
go back to reference Shevat, A.: Designing bots: Creating conversational experiences. “O’Reilly Media, Inc.” (2017) Shevat, A.: Designing bots: Creating conversational experiences. “O’Reilly Media, Inc.” (2017)
39.
go back to reference Hussain, S.A., Ogundimu, F., Bhattarai, S.: Mobile phone-based chatbot for family planning and contraceptive information. In: International Conference on Human-Computer Interaction, pp. 342–352. Springer (2019) Hussain, S.A., Ogundimu, F., Bhattarai, S.: Mobile phone-based chatbot for family planning and contraceptive information. In: International Conference on Human-Computer Interaction, pp. 342–352. Springer (2019)
40.
go back to reference Maarup, M., Dohan, M.S., Zhao, W., Wu, S.: Radical technological innovation and perception: A non-physician practitioners’ perspective. ICH ITA p. 45 (2019) Maarup, M., Dohan, M.S., Zhao, W., Wu, S.: Radical technological innovation and perception: A non-physician practitioners’ perspective. ICH ITA p. 45 (2019)
41.
go back to reference Sarwar, S., Dent, A., Faust, K., Richer, M., Djuric, U., Van Ommeren, R., Diamandis, P.: Physician perspectives on integration of artificial intelligence into diagnostic pathology. NPJ digital medicine 2(1), 1–7 (2019)CrossRef Sarwar, S., Dent, A., Faust, K., Richer, M., Djuric, U., Van Ommeren, R., Diamandis, P.: Physician perspectives on integration of artificial intelligence into diagnostic pathology. NPJ digital medicine 2(1), 1–7 (2019)CrossRef
42.
go back to reference Shawar, B.A., Atwell, E.: Arabic question-answering via instance based learning from an faq corpus. In: Proceedings of the CL 2009 International Conference on Corpus Linguistics. UCREL, vol. 386 (2009) Shawar, B.A., Atwell, E.: Arabic question-answering via instance based learning from an faq corpus. In: Proceedings of the CL 2009 International Conference on Corpus Linguistics. UCREL, vol. 386 (2009)
Metadata
Title
Development and Validation of Conversational Agent to Pregnancy Safe-education
Authors
João Luis Zeni Montenegro
Cristiano André da Costa
Rodrigo da Rosa Righi
Elson Romeu Farias
Lara Balen Matté
Publication date
01-12-2023
Publisher
Springer US
Published in
Journal of Medical Systems / Issue 1/2023
Print ISSN: 0148-5598
Electronic ISSN: 1573-689X
DOI
https://doi.org/10.1007/s10916-022-01903-2

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