Improving Access to Online Health Information With Conversational Agents: A Randomized Controlled Experiment.

BACKGROUND: Conventional Web-based search engines may be unusable by individuals with low health literacy for finding health-related information, thus precluding their use by this population. OBJECTIVE: We describe a conversational search engine interface designed to allow individuals with low health and computer literacy identify and learn about clinical trials on the Internet. METHODS: A randomized trial involving 89 participants compared the conversational search engine interface (n=43) to the existing conventional keyword- and facet-based search engine interface (n=46) for the National Cancer Institute Clinical Trials database. Each participant performed 2 tasks: finding a clinical trial for themselves and finding a trial that met prespecified criteria. RESULTS: Results indicated that all participants were more satisfied with the conversational interface based on 7-point self-reported satisfaction ratings (task 1: mean 4.9, SD 1.8 vs mean 3.2, SD 1.8, P<.001; task 2: mean 4.8, SD 1.9 vs mean 3.2, SD 1.7, P<.001) compared to the conventional Web form-based interface. All participants also rated the trials they found as better meeting their search criteria, based on 7-point self-reported scales (task 1: mean 3.7, SD 1.6 vs mean 2.7, SD 1.8, P=.01; task 2: mean 4.8, SD 1.7 vs mean 3.4, SD 1.9, P<.01). Participants with low health literacy failed to find any trials that satisfied the prespecified criteria for task 2 using the conventional search engine interface, whereas 36% (5/14) were successful at this task using the conversational interface (P=.05). CONCLUSIONS: Conversational agents can be used to improve accessibility to Web-based searches in general and clinical trials in particular, and can help decrease recruitment bias against disadvantaged populations.

Health literacy and usability of clinical trial search engines.

Several web-based search engines have been developed to assist individuals to find clinical trials for which they may be interested in volunteering. However, these search engines may be difficult for individuals with low health and computer literacy to navigate. The authors present findings from a usability evaluation of clinical trial search tools with 41 participants across the health and computer literacy spectrum. The study consisted of 3 parts: (a) a usability study of an existing web-based clinical trial search tool; (b) a usability study of a keyword-based clinical trial search tool; and (c) an exploratory study investigating users' information needs when deciding among 2 or more candidate clinical trials. From the first 2 studies, the authors found that users with low health literacy have difficulty forming queries using keywords and have significantly more difficulty using a standard web-based clinical trial search tool compared with users with adequate health literacy. From the third study, the authors identified the search factors most important to individuals searching for clinical trials and how these varied by health literacy level.

Designing Empathic Virtual Agents: Manipulating Animation, Voice, Rendering, and Empathy to Create Persuasive Agents.

Designers of virtual agents have a combinatorically large space of choices for the look and behavior of their characters. We conducted two between-subjects studies to explore the systematic manipulation of animation quality, speech quality, rendering style, and simulated empathy, and its impact on perceptions of virtual agents in terms of naturalness, engagement, trust, credibility, and persuasion within a health counseling domain. In the first study, animation was varied between manually created, procedural, or no animations; voice quality was varied between recorded audio and synthetic speech; and rendering style was varied between realistic and toon-shaded. In the second study, simulated empathy of the agent was varied between no empathy, verbal-only empathic responses, and full empathy involving verbal, facial, and immediacy feedback. Results show that natural animations and recorded voice are more appropriate for the agent's general acceptance, trust, credibility, and appropriateness for the task. However, for a brief health counseling task, animation might actually be distracting from the persuasive message, with the highest levels of persuasion found when the amount of agent animation is minimized. Further, consistent and high levels of empathy improve agent perception but may interfere with forming a trusting bond with the agent.