Background: Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration. Objective: With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent–delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent–patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings. Methods: MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent–patient working alliance; (2) to offer hybrid (human- and conversational agent–supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX. Results: Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made. Conclusions: This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a “team player” role but also show potential to improve health-relevant outcomes in chronic disease management.

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中文翻译：

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在涉及卫生保健专业人员、患者和家庭成员的慢性病管理中作为调解社会行为者的对话代理：多站点单臂可行性研究

背景：慢性病的成功管理需要医疗保健专业人员、患者和家庭成员之间相互信任的合作。旨在帮助医疗保健专业人员的可扩展对话代理可以通过接触患者及其家人的日常生活，以可扩展的方式在支持这种协作方面发挥重要作用。然而，迄今为止，尚不清楚担任此类角色的对话代理人是否会被接受，以及他们是否能够支持这种多方利益相关者协作。目标：儿童哮喘是慢性病管理的相关目标，本研究的目标如下：(1) 描述 MAX 的设​​计，对话代理提供的哮喘干预措施，支持医疗保健专业人员在日常生活中针对儿童-父母团队；(2) 评估 (a) MAX 的覆盖范围，(b) 对话代理-患者工作联盟，(c) MAX 的接受度，(d) 干预完成率，(e) 认知和行为结果，以及 (f)初级和二级保健机构中保健专业人员的人为努力和反应能力。方法：MAX 旨在提高 10-15 岁哮喘患者的认知技能（即有关哮喘的知识）和行为技能（即吸入技术），并能够得到健康专家和家庭成员的支持。为此，三个设计目标指导了开发：（1）建立对话式代理-患者工作联盟；(2) 提供混合（人工和会话代理支持）无处不在的指导；(3) 提供具有高经验价值的干预。一个由计算机科学家、哮喘专家和年轻患者及其父母组成的跨学科团队共同开发了干预措施。会话代理通过电子邮件与医疗保健专业人员进行通信，通过移动聊天应用程序与患者进行通信，并通过 SMS 文本消息与家庭成员进行通信。在初级和二级保健环境中进行了单臂可行性研究以评估 MAX。结果：结果表明 MAX 在其影响范围方面获得了总体积极评价（49.5%，49/99 的招募和符合条件的患者家庭成员团队参与），强大的患者对话代理工作联盟，以及所有相关利益相关者的高度接受. 而且，MAX 提高了认知和行为技能，干预完成率为 75.5%。在 275 次 (97.8%) 的辅导课程中，家庭成员支持了 269 次患者。大多数对话轮次 (99.5%) 是在患者和对话代理之间进行的，而不是在患者和医疗保健专业人员之间进行的，这表明 MAX 的可扩展性。此外，医疗保健专业人员评估吸入技术的时间不到 4 分钟，向患者提供相关反馈的时间不到 3 天。提出了若干改进建议。结论：这项研究提供了第一个证据，证明会话代理被设计为涉及医疗保健专业人员、患者和家庭成员的调解社会行为者，

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