Conversational Agents in Health Care: Scoping Review of Their Behavior Change Techniques and Underpinning Theory.

BACKGROUND: Conversational agents (CAs) are increasingly used in health care to deliver behavior change interventions. Their evaluation often includes categorizing the behavior change techniques (BCTs) using a classification system of which the BCT Taxonomy v1 (BCTTv1) is one of the most common. Previous studies have presented descriptive summaries of behavior change interventions delivered by CAs, but no in-depth study reporting the use of BCTs in these interventions has been published to date. OBJECTIVE: This review aims to describe behavior change interventions delivered by CAs and to identify the BCTs and theories guiding their design. METHODS: We searched PubMed, Embase, Cochrane's Central Register of Controlled Trials, and the first 10 pages of Google and Google Scholar in April 2021. We included primary, experimental studies evaluating a behavior change intervention delivered by a CA. BCTs coding followed the BCTTv1. Two independent reviewers selected the studies and extracted the data. Descriptive analysis and frequent itemset mining to identify BCT clusters were performed. RESULTS: We included 47 studies reporting on mental health (n=19, 40%), chronic disorders (n=14, 30%), and lifestyle change (n=14, 30%) interventions. There were 20/47 embodied CAs (43%) and 27/47 CAs (57%) represented a female character. Most CAs were rule based (34/47, 72%). Experimental interventions included 63 BCTs, (mean 9 BCTs; range 2-21 BCTs), while comparisons included 32 BCTs (mean 2 BCTs; range 2-17 BCTs). Most interventions included BCTs 4.1 "Instruction on how to perform a behavior" (34/47, 72%), 3.3 "Social support" (emotional; 27/47, 57%), and 1.2 "Problem solving" (24/47, 51%). A total of 12/47 studies (26%) were informed by a behavior change theory, mainly the Transtheoretical Model and the Social Cognitive Theory. Studies using the same behavior change theory included different BCTs. CONCLUSIONS: There is a need for the more explicit use of behavior change theories and improved reporting of BCTs in CA interventions to enhance the analysis of intervention effectiveness and improve the reproducibility of research.

#EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram.

PURPOSE: Limited research has evaluated the role of Social Networking Sites (SNS) in eating disorder (ED) recovery. While research has demonstrated the deleterious effects of pro-ED SNS content, less is known regarding SNS content documenting ED recovery. This study evaluates orientation towards help-seeking, ongoing ED warning signs and recovery themes on ED recovery SNS hashtags. METHODS: 600 Instagram posts were retrieved from two popular hashtags: #EDrecovery and #EatingDisorderRecovery. They were categorized into four thematic concerns: Food, Quotes, People or Others. Posts were analysed for behavioural and psychological signs of ED based on the Mental Health First Aid Eating Disorders Guidelines, and whether they encouraged seeking professional help. Thematic qualitative analysis to evaluate themes posted on recovery hashtags was conducted. RESULTS: Of the 600 posts, 405 were used for analysis. The majority of posts were on Food (49.6%), Quotes (24.2%) and People (22.7%). Behavioural and psychological signs suggestive of EDs were present in 18.0% and 22.5% of images, respectively. Only 9.4% of posts encouraged seeking professional help. Important themes that emerged from the qualitative analysis included the recovery journey, increased awareness and stigma for EDs and the development of a supportive community. CONCLUSIONS: Despite identifying with ED recovery, posts had a high prevalence of ongoing ED behaviour and low prevalence of help-seeking. Thematic analysis emphasized the role of recovery as a journey and the role of stigma and community in recovery. These findings suggest that SNSs could potentially be leveraged as a platform to improve help-seeking and encourage recovery for users with eating disorders. LEVEL OF EVIDENCE: Level V, descriptive study.