A Framework for Design of Conversational Agents to Support Health Self-Care for Older Adults.

OBJECTIVE: We examined the potential of conversational agents (CAs) to support older adults' self-care related to chronic illness in light of lessons learned from decades of pedagogical agent research, which investigates the impact and efficacy of CAs for a wide range of learners. BACKGROUND: The role of CAs in education (i.e., pedagogical agents) has been long studied, but their potential for supporting self-care has received less attention, especially for older adults. METHODS: We reviewed work on pedagogical agents and considered how it informs the design of CAs for older adults. We propose a framework for designing CAs to support older adult self-care, which organizes a review of work in this area and integration with the pedagogical agent literature. RESULTS: Our review of the pedagogical agent literature revealed an evolution from teaching machines to interactive, social systems that influence student motivational as well as learning outcomes. To integrate this review with work on CAs and self-care, we developed a framework that specifies how self-care goals evolve with stages of an illness, communication goals that support self-care at each stage, patient needs, and requirements for CAs to support these needs. The review identified an agenda for future research on CA functions and features that help older adults accept need for self-care, establish self-care, and sustain self-care over time. CONCLUSIONS: Integrating insights from the pedagogical agent literature with research on developing CAs for self-care defines an agenda for developing and evaluating CAs to help older adults manage illness.

Learner-Adaptive Educational Technology for Simulation in Healthcare: Foundations and Opportunities.

STATEMENT: Despite evidence that learners vary greatly in their learning needs, practical constraints tend to favor ''one-size-fits-all'' educational approaches, in simulation-based education as elsewhere. Adaptive educational technologies - devices and/or software applications that capture and analyze relevant data about learners to select and present individually tailored learning stimuli - are a promising aid in learners' and educators' efforts to provide learning experiences that meet individual needs. In this article, we summarize and build upon the 2017 Society for Simulation in Healthcare Research Summit panel discussion on adaptive learning. First, we consider the role of adaptivity in learning broadly. We then outline the basic functions that adaptive learning technologies must implement and the unique affordances and challenges of technology-based approaches for those functions, sharing an illustrative example from healthcare simulation. Finally, we consider future directions for accelerating research, development, and deployment of effective adaptive educational technology and techniques in healthcare simulation.

Virtual Sprouts: A Virtual Gardening Pilot Intervention Increases Self-Efficacy to Cook and Eat Fruits and Vegetables in Minority Youth.

OBJECTIVE: To examine the effect of the Virtual Sprouts intervention, an interactive multiplatform mobile gardening game, on dietary intake and psychosocial determinants of dietary behavior in minority youth. MATERIALS AND METHODS: In this quasi-experimental pilot intervention, 180 third-, fourth-, and fifth-grade students in Los Angeles Unified School District participated in a 3-week program that included three Virtual Sprouts gaming sessions, three in-school lessons, and three in-home activities, using a nutrition- and gardening-focused curriculum. Pre- and postintervention questionnaires were used to assess psychosocial determinants of dietary behavior, including knowledge about and self-efficacy to eat fruits and vegetables (FV). Data were collected on FV, whole grains, fiber, total sugar, added sugar, and energy from sugary beverages through the Block Kids Food Screener ("last week" version) for Ages 2-17. Repeated measures analysis of covariance models was used for continuous outcomes, controlling for age, sex, ethnicity, school, and free school lunch. RESULTS: After the intervention, the intervention group (n = 116) compared with the control group (n = 64) had a significantly improved self-efficacy to eat FV score (+1.6% vs. -10.3%, P = 0.01), and an improved self-efficacy to cook FV score (+2.9% vs. -5.0%, P = 0.05). There were no significant differences in dietary intake or self-efficacy to garden scores between intervention and control groups. CONCLUSION: The results from this 3-week pilot study suggest that an interactive mobile game with a nutrition- and gardening-focused curriculum can improve psychosocial determinants of dietary behavior in minority youth.

Serious Games for Health: Features, Challenges, Next Steps.

As articles in this journal have demonstrated over the past 3 years, serious game development continues to flourish as a vehicle for formal and informal health education. How best to characterize a "serious" game remains somewhat elusive in the literature. Many researchers and practitioners view serious games as capitalizing on computer technology and state-of-the-art video graphics as an enjoyable means by which to provide and promote instruction and training, or to facilitate attitude change among its players. We invited four distinguished researchers and practitioners to further discuss with us how they view the characteristics of serious games for health, how those characteristics differ from those for academic purposes, the challenges posed for serious game development among players of different ages, and next steps for the development and empirical examination of the effectiveness of serious games for players' psychological and physical well-being.