Instrumental, Affective, and Patient-Centered Communication Between Cardiologists and Patients with Low Socioeconomic Status: An Observational Study.

One of the essential elements in managing health is having adequate communication with health care providers. Unfortunately, patients with a low socioeconomic status (SES) often experience less adequate communication with their doctor. In the current study, we explore and compare the communication of both doctors and patients from lower and higher sociodemographic backgrounds on three factors: instrumental, affective, and patient-centered communication. In total, 45 cardiology consultations were observed, transcribed, and coded (16 low-SES, 16 middle-SES, 13 high-SES). Our analyses showed that, compared to higher-SES patients, low-SES patients voiced less of their concerns, answered questions of the doctor more often with one word, and expressed less utterances overall. Naturally, we found that doctors expressed more utterances overall toward low-SES patients. For doctors, no differences regarding instrumental, affective, or patient-centered communication were found. These findings suggest that low-SES patients are more passive communicators and communication differences based on SES exist predominantly for patients' communication. The revealed communication differences may lead to a less adequate interaction and potentially worse patient outcomes, further increasing the socioeconomic health gap. Hence, doctors should become even more aware of socioeconomic patient communication differences so that they can appropriately encourage low-SES patients to become more active communicators.

Effectiveness and User Experience of a Smoking Cessation Chatbot: Mixed Methods Study Comparing Motivational Interviewing and Confrontational Counseling.

BACKGROUND: Cigarette smoking poses a major public health risk. Chatbots may serve as an accessible and useful tool to promote cessation due to their high accessibility and potential in facilitating long-term personalized interactions. To increase effectiveness and acceptability, there remains a need to identify and evaluate counseling strategies for these chatbots, an aspect that has not been comprehensively addressed in previous research. OBJECTIVE: This study aims to identify effective counseling strategies for such chatbots to support smoking cessation. In addition, we sought to gain insights into smokers' expectations of and experiences with the chatbot. METHODS: This mixed methods study incorporated a web-based experiment and semistructured interviews. Smokers (N=229) interacted with either a motivational interviewing (MI)-style (n=112, 48.9%) or a confrontational counseling-style (n=117, 51.1%) chatbot. Both cessation-related (ie, intention to quit and self-efficacy) and user experience-related outcomes (ie, engagement, therapeutic alliance, perceived empathy, and interaction satisfaction) were assessed. Semistructured interviews were conducted with 16 participants, 8 (50%) from each condition, and data were analyzed using thematic analysis. RESULTS: Results from a multivariate ANOVA showed that participants had a significantly higher overall rating for the MI (vs confrontational counseling) chatbot. Follow-up discriminant analysis revealed that the better perception of the MI chatbot was mostly explained by the user experience-related outcomes, with cessation-related outcomes playing a lesser role. Exploratory analyses indicated that smokers in both conditions reported increased intention to quit and self-efficacy after the chatbot interaction. Interview findings illustrated several constructs (eg, affective attitude and engagement) explaining people's previous expectations and timely and retrospective experience with the chatbot. CONCLUSIONS: The results confirmed that chatbots are a promising tool in motivating smoking cessation and the use of MI can improve user experience. We did not find extra support for MI to motivate cessation and have discussed possible reasons. Smokers expressed both relational and instrumental needs in the quitting process. Implications for future research and practice are discussed.

Effectiveness and Acceptability of Conversational Agents for Smoking Cessation: A Systematic Review and Meta-analysis.

INTRODUCTION: Conversational agents (CAs; computer programs that use artificial intelligence to simulate a conversation with users through natural language) have evolved considerably in recent years to support healthcare by providing autonomous, interactive, and accessible services, making them potentially useful for supporting smoking cessation. We performed a systematic review and meta-analysis to provide an overarching evaluation of their effectiveness and acceptability to inform future development and adoption. AIMS AND METHODS: PsycInfo, Web of Science, ACM Digital Library, IEEE Xplore, Medline, EMBASE, Communication and Mass Media Complete, and CINAHL Complete were searched for studies examining the use of CAs for smoking cessation. Data from eligible studies were extracted and used for random-effects meta-analyses. RESULTS: The search yielded 1245 publications with 13 studies eligible for systematic review (total N = 8236) and six studies for random-effects meta-analyses. All studies reported positive effects on cessation-related outcomes. A meta-analysis with randomized controlled trials reporting on abstinence yielded a sample-weighted odds ratio of 1.66 (95% CI = 1.33% to 2.07%, p < .001), favoring CAs over comparison groups. A narrative synthesis of all included studies showed overall high acceptability, while some barriers were identified from user feedback. Overall, included studies were diverse in design with mixed quality, and evidence of publication bias was identified. A lack of theoretical foundations was noted, as well as a clear need for relational communication in future designs. CONCLUSIONS: The effectiveness and acceptability of CAs for smoking cessation are promising. However, standardization of reporting and designing of the agents is warranted for a more comprehensive evaluation. IMPLICATIONS: This is the first systematic review to provide insight into the use of CAs to support smoking cessation. Our findings demonstrated initial promise in the effectiveness and user acceptability of these agents. We also identified a lack of theoretical and methodological limitations to improve future study design and intervention delivery.

Can chatbots help to motivate smoking cessation? A study on the effectiveness of motivational interviewing on engagement and therapeutic alliance.

BACKGROUND: Cigarette smoking poses a major threat to public health. While cessation support provided by healthcare professionals is effective, its use remains low. Chatbots have the potential to serve as a useful addition. The objective of this study is to explore the possibility of using a motivational interviewing style chatbot to enhance engagement, therapeutic alliance, and perceived empathy in the context of smoking cessation. METHODS: A preregistered web-based experiment was conducted in which smokers (n = 153) were randomly assigned to either the motivational interviewing (MI)-style chatbot condition (n = 78) or the neutral chatbot condition (n = 75) and interacted with the chatbot in two sessions. In the assessment session, typical intake questions in smoking cessation interventions were administered by the chatbot, such as smoking history, nicotine dependence level, and intention to quit. In the feedback session, the chatbot provided personalized normative feedback and discussed with participants potential reasons to quit. Engagement with the chatbot, therapeutic alliance, and perceived empathy were the primary outcomes and were assessed after both sessions. Secondary outcomes were motivation to quit and perceived communication competence and were assessed after the two sessions. RESULTS: No significant effects of the experimental manipulation (MI-style or neutral chatbot) were found on engagement, therapeutic alliance, or perceived empathy. A significant increase in therapeutic alliance over two sessions emerged in both conditions, with participants reporting significantly increased motivation to quit. The chatbot was perceived as highly competent, and communication competence was positively associated with engagement, therapeutic alliance, and perceived empathy. CONCLUSION: The results of this preregistered study suggest that talking with a chatbot about smoking cessation can help to motivate smokers to quit and that the effect of conversation has the potential to build up over time. We did not find support for an extra motivating effect of the MI-style chatbot, for which we discuss possible reasons. These findings highlight the promise of using chatbots to motivate smoking cessation. Implications for future research are discussed.

Social attraction in video-mediated communication: The role of nonverbal affiliative behavior.

The first aim of this study was to analyze video-mediated communication (VMC), in comparison to face-to-face (FTF) communication, and the effect it has on how communicators express nonverbal affiliative behaviors relevant for social attraction. Second, this study aimed to discover whether these nonverbal expressions relate to communicators' social attraction. An experiment with 93 cross-sex dyads was conducted, with a get-acquainted exercise in a VMC or a FTF condition. Our findings revealed that communicators in VMC smiled more and spoke louder. In addition, VMC interactants displayed less facial touching than FTF interactants. Finally, more gaze aversion and a higher speech rate were found to influence social attraction. These findings have implications for research on cue-rich computer-mediated communication (CMC) and the way in which communicators nonverbally express themselves in comparison to copresent FTF communication. Additionally, this study has implications for social information processing theory which may be extended to include cue-rich forms of CMC.

Under the bridge: An in-depth examination of online trolling in the gaming context.

Trolling is a subject of apparent academic confusion; the few studies conducted thus far yielded a variety of conflicting definitions regarding what constitutes trolling behaviour and little information regarding trolling motivations. In order to shed further light on this phenomenon, the present study aimed to (1) determine which behaviours actual trolls consider as trolling, (2) explore the motivations behind trolling, and (3) examine the online community's response to trolling as perceived by the troll. After performing semi-structured interviews with 22 self-confessed trolls, we found that there is a variety of behaviours trolls consider trolling which can now be put in clear categories based on target and method. Three key motivations to troll emerged: personal enjoyment, revenge, and thrill-seeking. Trolling also appears to be a cyclical, self-perpetuating phenomenon enabled by the online community at large. Theoretical implications for future trolling research are also discussed.

The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients.

BACKGROUND: Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. OBJECTIVE: This study aimed to examine (1) the impact of a consultation medium on doctors' and patients' communicative behavior in terms of information exchange, interpersonal relationship building, and shared decision making and (2) the mediating role of doctors' and patients' communicative behavior on satisfaction with both types of consultation medium. METHODS: Doctor-patient consultations on pelvic organ prolapse were simulated, both in a face-to-face and in a screen-to-screen (video) setting. Twelve medical interns and 6 simulated patients prepared 4 different written scenarios and were randomized to perform a total of 48 consultations. Effects of the consultations were measured by questionnaires that participants filled out directly after the consultation. RESULTS: With respect to patient-related outcomes, satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making showed no significant differences between face-to-face and screen-to-screen consultations. Patients' attitude toward Web-based communication (b=-.249, P=.02 and patients' perceived time and attention (b=.271, P=.03) significantly predicted patients' perceived interpersonal relationship building. Patients' perceived shared decision making was positively related to their satisfaction with the consultation (b=.254, P=.005). Overall, patients experienced significantly greater shared decision making with a female doctor (mean 4.21, SD 0.49) than with a male doctor (mean 3.66 [SD 0.73]; b=.401, P=.009). Doctor-related outcomes showed no significant differences in satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making between the conditions. There was a positive relationship between perceived information exchange and doctors' satisfaction with the consultation (b=.533, P<.001). Furthermore, doctors' perceived interpersonal relationship building was positively related to doctors' satisfaction with the consultation (b=.331, P=.003). CONCLUSIONS: In this study, the quality of doctor-patient communication, as indicated by information exchange, interpersonal relationship building, and shared decision making, did not differ significantly between Web-based and face-to-face consultations. Doctors and simulated patients were equally satisfied with both types of consultation medium, and no differences were found in the manner in which participants perceived communicative behavior during these consultations. The findings suggest that worries about a negative impact of Web-based video consultation on the quality of patient-provider consultations seem unwarranted as they offer the same interaction quality and satisfaction level as regular face-to-face consultations.

Using Digital Communication Technology to Improve Neonatal Care: Two-Part Explorative Needs Assessment.

BACKGROUND: The birth of a premature infant and subsequent hospitalization are stressful events for parents. Therefore, accurate and easy-to-understand communication between parents and health care professionals is crucial during this period. Mobile health (mHealth) technologies have the potential to improve communication with parents at any time and place and possibly reduce their stress. OBJECTIVE: We aimed to conduct a 2-part explorative needs assessment in which the interaction between the pediatrician and parents was examined along with their digital communication technology needs and interest in an mHealth app with the aim of improving interpersonal communication and information exchange. METHODS: Overall, 19 consultations between parents of preterm infants and pediatricians were observed to determine which themes are discussed the most and the number of questions asked. Afterward, the parents and the pediatrician were interviewed to evaluate the process of communication and gauge their ideas about a neonatal communication mHealth app. RESULTS: The observations revealed the following most prevalent themes: breastfeeding, criteria for discharge, medication, and parents' personal life. Interview data showed that the parents were satisfied with the communication with their pediatrician. Furthermore, both parents and pediatricians expected that a neonatal mHealth app could further improve the communication process and the hospital stay. Parents valued app features such as asking questions, growth graphs, a diary function, hospital-specific information, and medical rounds reports. CONCLUSIONS: Both parents of hospitalized preterm infants and pediatricians expect that the hypothetical mHealth app has the potential to cater to the most prevalent themes and improve communication and information exchange. Recommendations for developing such an app and its possible features are also discussed. On the basis of these promising results, it is suggested to further develop and study the effects of the mHealth app together with all stakeholders.

Exploring the impact of patient, physician and technology factors on patient video consultation satisfaction.

Objective: Video consultations (VCs) were made available to the general population during the COVID-19 pandemic to compensate for the cutback of face-to-face doctor-patient interactions. However, little is known about what patient-related (e.g. age), physician-related (e.g. patient-physician relationship) and technology-related (e.g. online privacy concerns) factors contribute to video consultation satisfaction among patients. This study aims to gain a better understanding of what makes patients satisfied with video consultations. Methods: A total of 180 patients who recently engaged in a video consultation were invited to answer questions about patient-, physician- and technology-related variables and their satisfaction with the video consultation. To examine which factors predict patient video consultation satisfaction, a multiple hierarchical regression analysis was performed. Results: Overall, patients were satisfied with their video consultation. The final hierarchical model, including all patient-related, physician-related and technology-related factors, significantly contributed to patient video consultation satisfaction. Predictors of higher patient video consultation satisfaction were experiencing less technical issues, having higher general positive attitudes towards online communication, reporting higher importance of less travel time and being more satisfied with physicians' affective and instrumental communication. Conclusions: Video consultations can be appropriate in a variety of situations, provided that technical issues can be minimized, patients have a positive attitude towards online communication and attach value to reduced travel time and online patient-physician interactions can be experienced as affective and instrumental. Findings from this study contribute to understanding how video consultations can be best utilized for effective patient-physician communication.

Social Support Among Women With Potential Essure-Related Complaints: Analysis of Facebook Group Content.

BACKGROUND: Social support groups are an important resource for people to cope with problems. Previous studies have reported the different types of support in these groups, but little is known about the type of reactions that sharing of personal experiences induce among members. It is important to know how and to what extent members of support groups influence each other regarding the consumption of medical care. We researched this in a web-based Facebook group of women sterilized with Essure. Essure was a device intended for permanent contraception. From 2015 onward, women treated with Essure for tubal occlusion raised safety concerns and numerous complaints. OBJECTIVE: This study aimed to evaluate the use of social support in a Facebook community named "Essure problemen Nederland" (EPN; in English, "Essure problems in the Netherlands"). METHODS: All posts in the closed Facebook group EPN between March 8 and May 8, 2018, were included. In total, 3491 Facebook posts were analyzed using a modified version of the Social Support Behavior Codes framework created by Cutrona and Suhr in 1992. Posts were abstracted and aggregated into a database. Two investigators evaluated the posts, developed a modified version of the Social Support Behavior Codes framework, and applied the codes to the collected data. RESULTS: We found that 92% of messages contained a form of social support. In 68.8% of posts, social support was provided, and in 31.2% of posts, social support was received. Informational and emotional support was the most frequently used form of provided social support (40.6% and 55.5%, respectively). The same distribution was seen with received social support: informational support in 81.5% and emotional support in 17.4% of cases. Our analysis showed a strong correlation between providing or receiving social support and the main form of social support (P<.001). In a total of only 74 (2.2%) cases, women advised each other to seek medical care. CONCLUSIONS: The main purpose of women in the EPN Facebook group was to provide and receive informational or emotional support or both.

Trolls Without Borders: A Cross-Cultural Examination of Victim Reactions to Verbal and Silent Aggression Online.

Trolling-the online exploitation of website, chat, or game mechanics at another user's expense-can and does take place all over cyberspace. It can take myriad forms, as well-some verbal, like trash-talking an opponent in a game, and some silent, like refusing to include a new player in a team effort during an in-game quest. However, despite this variety, there are few to no studies comparing the effects of these differing trolling types on victims. In addition, no study has yet taken into account users' offline cultural context and norms into the trolling victim experience. To fill this gap in the literature, the present study put participants from three culturally-distinct countries-Pakistan, Taiwan, and the Netherlands-in a simulated trolling interaction using the Cyberball game. Participants were either flamed (read: harshly insulted) or ostracized by a member of their own cultural group (ingroup) or a minority member (outgroup), and the participants' emotional responses, behavioral intentions toward the other players, and messages sent during the game were taken as indicators of their response to the trolling. Results showed that our Taiwanese sample used the most reactive aggression when trolled and our Dutch sample was the most passive. In addition, ostracism generally produced the desire to repair relationships, irrespective of cultural context, and perpetrator culture (ingroup or outgroup) only produced an effect in the behavioral intentions of our Pakistani sample. Overall, it would appear that online and offline culture interact to produce the variety of responses to trolling seen in extant literature. Additional implications for future research into computer-mediated communication and online aggression are also discussed.

Computer-mediated communication and interpersonal attraction: an experimental test of two explanatory hypotheses.

The aims of this study were (a) to investigate the influence of computer-mediated communication (CMC) on interpersonal attraction and (b) to examine two underlying processes in the CMC-interpersonal attraction relationship. We identified two variables that may mediate the influence of CMC on interpersonal attraction: self-disclosure and direct questioning. Focusing on these potential mediating variables, we tested two explanatory hypotheses: the CMC-induced direct questioning hypothesis and the CMC-induced self-disclosure hypothesis. Eighty-one cross-sex dyads were randomly assigned to one of three experimental conditions: text-only CMC, visual CMC, and face-to-face communication. We did not find a direct effect of CMC on interpersonal attraction. However, we did find two positive indirect effects of text-only CMC on interpersonal attraction: text-only CMC stimulated both self-disclosure and direct questioning, both of which in turn enhanced interpersonal attraction. Results are discussed in light of uncertainty reduction theory and CMC theories.

Patients' and health professionals' use of social media in health care: motives, barriers and expectations.

OBJECTIVE: To investigate patients' and health professionals' (a) motives and use of social media for health-related reasons, and (b) barriers and expectations for health-related social media use. METHODS: We conducted a descriptive online survey among 139 patients and 153 health care professionals in obstetrics and gynecology. In this survey, we asked the respondents about their motives and use of social network sites (SNS: Facebook and Hyves), Twitter, LinkedIn, and YouTube. RESULTS: Results showed that patients primarily used Twitter (59.9%), especially for increasing knowledge and exchanging advice and Facebook (52.3%), particularly for social support and exchanging advice. Professionals primarily used LinkedIn (70.7%) and Twitter (51.2%), for communication with their colleagues and marketing reasons. Patients' main barriers for social media use were privacy concerns and unreliability of the information. Professionals' main barriers were inefficiency and lack of skills. Both patients and professionals expected future social media use, provided that they can choose their time of social media usage. CONCLUSION: The results indicate disconcordance in patients' and professionals' motives and use of social media in health care. PRACTICE IMPLICATIONS: Future studies on social media use in health care should not disregard participants' underlying motives, barriers and expectations regarding the (non)use of social media.