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Massive Open Online Courses (MOOCs) make up a teaching modality that aims to reach a large number of students using Virtual Learning Environments. In these courses, the intervention of tutors and teachers is essential to support students in the teaching-learning process, answer questions about their content, and provide engagement for students. However, as these courses have a vast and diverse audience, tutors and teachers find it difficult to monitor them closely and efficiently with prompt interventions. This work proposes an architecture to favor the construction of knowledge for students, tutors, and teachers through autonomous interference and recommendations of educational resources. The architecture is based on a conversational agent and an educational recommendation system. For the training of predictive models and extraction of semantic information, ontology and logical rules were used, together with inference algorithms and machine learning techniques, which act on a dataset with messages exchanged between course forum participants in the humanities, medicine, and education fields. The messages are classified according to the type (question, answer, and opinion) and parameters about feeling, confusion, and urgency. The architecture can infer the moment in which a student needs help and, through a Conversational Recommendation System, provides the student with the opportunity to revise his or her knowledge on the subject. To help in this task, the architecture can provide educational resources via an autonomous agent, contributing to reducing the degree of confusion and urgency identified in the posts. Initial results indicate that integrating technologies and resources, complementing each other, can support the students and help them succeed in their educational training.

One important problem in MOOCs is the lack of personalized support from teachers. Conversational agents arise as one possible solution to assist MOOC learners and help them to study. For example, conversational agents can help review key concepts of the MOOC by asking questions to the learners and providing examples. JavaPAL, a voice-based conversational agent for supporting learners on a MOOC on programming with Java offered on edX. This paper evaluates JavaPAL from different perspectives. First, the usability of JavaPAL is analyzed, obtaining a score of 74.41 according to a System Usability Scale (SUS). Second, learners’ performance is compared when answering questions directly through JavaPAL and through the equivalent web interface on edX, getting similar results in terms of performance. Finally, interviews with JavaPAL users reveal that this conversational agent can be helpful as a complementary tool for the MOOC due to its portability and flexibility compared to accessing the MOOC contents through the web interface. This work was supported in part by the FEDER/Ministerio de Ciencia, Innovación y Universidades-Agencia Estatal de Investigación, through the Smartlet and H2O Learning projects under Grant TIN2017-85179-C3-1-R and PID2020-112584RB-C31, and in part by the Madrid Regional Government through the e-Madrid-CM Project under Grant S2018/TCS-4307 and under the Multiannual Agreement with UC3M in the line of Excellence of University Professors (EPUC3M21), and in the context of the V PRICIT (Regional Programme of Research and Technological Innovation), a project which is co-funded by the European Structural Funds (FSE and FEDER). Partial support has also been received from the European Commission through Erasmus+ Capacity Building in the Field of Higher Education projects, more specifically through projects LALA, InnovaT, and PROF-XXI (586120-EPP-1-2017-1-ES-EPPKA2-CBHE-JP), (598758-EPP-1-2018-1-AT-EPPKA2-CBHE-JP), (609767-EPP-1-2019-1-ES-EPPKA2-CBHE-JP). This publication reflects the views only of the authors and funders cannot be held responsible for any use which may be made of the information contained therein.

While massive open online courses (MOOCs) can be effective in scaling education, orchestrating collaborative learning activities for large audiences remains a non-trivial task that introduces a series of practical challenges, such as the lack of adequate human support. Even when collaboration takes place, there is uncertainty whether meaningful interactions will occur among learners. This work presents the architecture of a prototype system called PeerTalk. The system was created to enable instructors to easily incorporate real-time collaborative learning activities into their online courses. Furthermore, PeerTalk employs a conversational agent service that aims to scaffold students’ online collaboration and provide valuable guidance, which can be configured by the course instructor. In order to investigate the user-acceptance of the system, two evaluation studies took place. The first one involved a group of experts, i.e., MOOC instructors who are expected to use such a system in their course, whereas the second study featured 44 postgraduate students. The study findings were encouraging in terms of the system efficiency and usability levels, laying the foundation for a conversational agent service, which can effectively scale the support of the teaching staff and be easily integrated in MOOC platforms, creating further opportunities for valuable social interaction among learners.

International audience; Conversational agents such as robots or chatbots are today proposed as a solution to modern societys’ issues such as loneliness. This paper explores the effect of the evolution of a conversational agent appearance (Replika©) on user reviews (~ 85 000) through the use of Reinert’s method for text analysis. Results showed differences in the size of thematics issued from the analysis before and after the update such as help with mental health, companionship and visual and conversational anthropomorphism.

Conversational agents also known as Chatbots are the future of human-machine interaction. Classes with large number of students turn out to be a source of worry to the lecturers since they have to respond to their inquiries immediately. Embedding Chatbots in education systems is a necessity to boost the interaction between students and lectures especially those shy students feel ashamed of asking. Such systems possibly will assist the students to attain better learning outcomes. This paper presents Labeeb (Wiseman in Arabic) a conversational agents respond to student inquiries in specific course, objectives, learning outcomes and academic rules and regulations. Labeeb receives either text or speech inquiries, then respond in both written text and speech reply.

Massive open online courses (MOOCs) pose a challenge for instructors when trying to provide personalised support to learners, due to large numbers of registered participants. Conversational agents can be of help to support learners when working with MOOCs. This article presents an adaptive learning module for JavaPAL, a conversational agent that complements a MOOC on Java programming, helping learners review the key concepts of the MOOC. This adaptive learning module adapts the difficulty of the questions provided to learners considering their level of knowledge using item response theory (IRT) and also provides recommendations of video fragments extracted from the MOOC for when learners fail questions. The adaptive learning module for JavaPAL has been evaluated showing good usability and learnability through the system usability scale (SUS), reasonably suitable video fragments recommendations for learners, and useful visualisations generated as part of the IRT-based adaptation of questions for instructors to better understand what is happening in the course, to design exams, and to redesign the course content. This work was supported in part by the FEDER/Ministerio de Ciencia, Innovación y Universidades–Agencia Estatal de Investigación, through the Smartlet Project under Grant TIN2017-85179-C3-1-R, and in part by the Madrid Regional Government through the e-Madrid-CM Project under Grant S2018/TCS-4307, a project which is co-funded by the European Structural Funds (FSE and FEDER). Partial support has also been received from the European Commission through Erasmus+ Capacity Building in the Field of Higher Education projects, more specifically through projects LALA, InnovaT and PROF-XXI (586120-EPP-1-2017-1-ES-EPPKA2-CBHE-JP), (598758-EPP-1-2018-1-AT-EPPKA2-CBHE-JP), (609767-EPP-1-2019-1-ES-EPPKA2-CBHE-JP). This work has also been supported by the Madrid Government (Comunidad de Madrid-Spain) under the Multiannual Agreement with UC3M in the line of Excellence of University Professors (EPUC3M21), and in the context of the V PRICIT (Regional Programme of Research and Technological Innovation).This publication reflects the views only of the authors and funders cannot be held responsible for any use which may be made of the information contained therein.

Automation in driving will change the role of the drivers from actor to passive supervisor. Although the vehicle will be responsible for driving manoeuvres, drivers will need to rely on automation and understand its decisions to establish a trusting relationship between them and the vehicle. Progress has been made in conversational agents and affective machines recently. Moreover, it seems to be promising in this establishment of trust between humans and machines. We believe it is essential to investigate the use of emotional conversational agents in the automotive context to build a solid relationship between the driver and the vehicle. In this workshop, we aim at gathering researchers and industry practitioners from different fields of HCI, ML/AI, NLU and psychology to brainstorm about affective machines, empathy and conversational agent with a particular focus on human-vehicle interaction. Questions like ”What would be the specificities of a multimodal and empathic agent in a car?”, ”How the agent could make the driver aware of the situation?” and ”How to measure the trust between the user and the autonomous vehicle?” will be addressed in this workshop.

Context. Asynchronous messaging is increasingly used to support human–machine interactions, generally implemented through chatbots. Such virtual entities assist the users in activities of different kinds (e.g., work, leisure, and health-related) and are becoming ingrained into humans’ habits due to factors including (i) the availability of mobile devices such as smartphones and tablets, (ii) the increasingly engaging nature of chatbot interactions, (iii) the release of dedicated APIs from messaging platforms, and (iv) increasingly complex AI-based mechanisms to power the bots’ behaviors. Nevertheless, most of the modern chatbots rely on state machines (implementing conversational rules) and one-fits-all approaches, neglecting personalization, data-stream privacy management, multi-topic management/interconnection, and multimodal interactions. Objective. This work addresses the challenges above through an agent-based framework for chatbot development named EREBOTS. Methods. The foundations of the framework are based on the implementation of (i) multi-front-end connectors and interfaces (i.e., Telegram, dedicated App, and web interface), (ii) enabling the configuration of multi-scenario behaviors (i.e., preventive physical conditioning, smoking cessation, and support for breast-cancer survivors), (iii) online learning, (iv) personalized conversations and recommendations (i.e., mood boost, anti-craving persuasion, and balance-preserving physical exercises), and (v) responsive multi-device monitoring interface (i.e., doctor and admin). Results. EREBOTS has been tested in the context of physical balance preservation in social confinement times (due to the ongoing pandemic). Thirteen individuals characterized by diverse age, gender, and country distribution have actively participated in the experimentation, reporting advancements in the physical balance and overall satisfaction of the interaction and exercises’ variety they have been proposed.

Background: Effective treatments for various conditions such as obesity, cardiac heart diseases, or low back pain require not only personal on-site coaching sessions by health care experts but also a significant amount of home exercises. However, nonadherence to home exercises is still a serious problem as it leads to increased costs due to prolonged treatments. Objective: To improve adherence to home exercises, we propose, implement, and assess the novel coaching concept of hybrid ubiquitous coaching (HUC). In HUC, health care experts are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality environment. Methods: We applied HUC to the field of physiotherapy and conducted 4 design-and-evaluate loops with an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients’ perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a 4-week n-of-1 trial was conducted with 1 patient to show one experience with HUC in depth and thereby potentially reveal real-world benefits and challenges. Results: Patients perceived HUC to be useful, easy to use, and enjoyable, preferred it to state-of-the-art approaches, and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an augmented reality–based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92% (11/12 sessions; 330/360 repetitions; 33/36 sets) and a substantial increase in exercise accuracy during the 4 weeks. Conclusions: The overall positive assessments from both patients and health care experts suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises and test HUC with patients suffering from different disorders., Journal of Medical Internet Research, 23 (2), ISSN:1438-8871

The growing popularity of smart-speakers in recent years has led to increased interest in the capacity of Conversational Agents (CAs) to support health and wellbeing. This extends to their potential to engage users in human-like conversations as means of gathering self-reported health data. Prior research has focused on the optimization of CAs for the collection of discrete responses to standardized questionnaires. Less research however, has investigated how a more conversational modality shapes what people recount of their wellbeing nor what they make of the experience. This paper presents the findings of a lab-based random assignment study contrasting 59 participants’ experiences of two distinct designs of a CA named Sofia — each separately enabling discrete or open-ended responses to the World Health Organization-Five Wellbeing Index (WHO-5) questionnaire. Analysis of task completion times, Speech-System Interface Usability (SASSI) scores, and coherence between verbal and paper-based responses suggests that CAs can serve as a feasible means of gathering self-reported health data, although users report finding discrete response options more habitable (i.e. easier to grasp) than an open-ended alternative. We discuss the implications of these findings for the design of CAs to support the self-report of health and wellbeing, and highlight future research directions.

There is an increasing shift towards the use of conversational agents, or chatbots, thanks to their inclusion in consumer hardware (e.g. Alexa, Siri and Google Assistant) and the growing number of essential services moving online. A chatbot allows an organisation to deal with a large volume of user queries with minimal overheads, which in turn allows human operators to deal with more complex issues. In this paper we present our work on maximising responsible, sensitive disclosures to chatbots. The paper focuses on two key studies, the first of which surveyed participants to establish the relative sensitivity of a range of disclosures. From this, we found that participants were equally comfortable making financial disclosures to a chatbot as to a human. The second study looked to support the dynamic personalisation of the chatbot in order to improve the disclosures. This was achieved by exploiting behavioural biometrics (keystroke and mouse dynamics) to identify demographic information about anonymous users. The research highlighted that a fusion approach, combining both keyboard and mouse dynamics, was the most reliable predictor of these biographic characteristics.

Previous studies suggest that engagement in musical activities may enhance well-being and impact social inclusion. However, unfortunately, people with physical disabilities cannot often use musical instruments or music production software due to accessibility issues. We propose Boris, an original conversational agent specific for people with a physical disability, to entertain, stimulate expressiveness, and promote communication. Boris enables (even inexperienced) users to compose songs through hands-free interaction by analyzing their vocalizations to obtain more than just their transcription: the system listens to the user even while humming a song and generates a melody by learning and reproducing their human voice patterns. Indeed, it exploits an artificial musical intelligence that can imitate the typically human cognitive skills to produce music using an advanced technique called abstract melody.

The current research proposes a technological system "NESTORE" designed for and with older adults in four different countries in order to improve and sustain their wellbeing. The system personalized activities and architecture, co-designed interfaces, and its multilingual aspect aim to establish an 'inclusion' criterion based on the user's sociocultural profile and health condition.

One of the key aspects in the process of caring for people with diabetes is Therapeutic Education (TE). TE is a teaching process for training patients so that they can self-manage their care plan. Alongside traditional methods of providing educational content, there are now alternative forms of delivery thanks to the implementation of advanced Information Technologies systems such as conversational agents (CAs). In this context, we present the AIDA project: an ensemble of two different CAs intended to provide a TE tool for people with diabetes. The Artificial Intelligence Diabetes Assistant (AIDA) consists of a text-based chatbot and a speech-based dialog system. Their content has been created and validated by a scientific board. AIDA Chatbot—the text-based agent—provides a broad spectrum of information about diabetes, while AIDA Cookbot—the voice-based agent—presents recipes compliant with a diabetic patient’s diet. We provide a thorough description of the development process for both agents, the technology employed and their usage by the general public. AIDA Chatbot and AIDA Cookbot are freely available and they represent the first example of conversational agents in Italian to support diabetes patients, clinicians and caregivers. Supplementary Information The online version contains supplementary material available at 10.1007/s44163-021-00005-1.

Empowerment is a process through which people acquire the necessary knowledge and self-awareness to understand their conditions and treatment options, make informed choices and self-manage their health conditions in daily life, in collaboration with medical professionals. Conversational Agents in healthcare could play an important role in the process of empowering a person but, so far, they have been seldom been used for this purpose. This paper presents the basic principles and preliminary implementation of a conversational health agent for patient empowerment. It dialogues with the user in a "natural" way, collects health data from heterogeneous sources and provides the user with specific and relevant information. This allows a person/patient to create his/her own opinion on health matters in the most complete and objective way, and, therefore, it facilitates the empowerment process.

In the last years, the rise of digital technologies has enormously augmented the possibility for people to access health information and consult online versions of Patient Information Leaflets (PILs), enabling them to improve their knowledge about medication and adherence to therapies. However, health information may often be difficult to consult and comprehend due to an excessively lengthy and undersized text, coupled with the presence of many incomprehensible medical terms. To face these issues, this paper proposes a conversational agent as a valuable solution to simplify health information retrieval and improve health literacy in Italian by codifying PILs and making them query-able in natural language. In particular, the system has been devised to: i) comprehend natural language questions on medicines of interest; ii) proactively ask the user or automatically infer from the dialog state all the missing information necessary to generate an answer; iii) extract the answer from a structured knowledge base built from PILs of registered drugs. An experimental study has been carried out to evaluate both the performance and usability of the proposed system. Results showed an adequate ability of the system to handle most of the dialogues started by participants correctly, good users satisfaction, and, thus, proved its feasibility and usefulness.

Artificial intelligence virtual health assistants are a promising emerging technology. This study is a process evaluation of a 12-week pilot physical activity and diet program delivered by virtual assistant &ldquo, Paola&rdquo, This single-arm repeated measures study (n = 28, aged 45&ndash, 75 years) was evaluated on technical performance (accuracy of conversational exchanges), engagement (number of weekly check-ins completed), adherence (percentage of step goal and recommended food servings), and user feedback. Paola correctly asked scripted questions and responded to participants during the check-ins 97% and 96% of the time, respectively, but correctly responded to spontaneous exchanges only 21% of the time. Participants completed 63% of weekly check-ins and conducted a total of 3648 exchanges. Mean dietary adherence was 91% and was lowest for discretionary foods, grains, red meat, and vegetables. Participants met their step goal 59% of the time. Participants enjoyed the program and found Paola useful during check-ins but not for spontaneous exchanges. More in-depth knowledge, personalized advice and spontaneity were identified as important improvements. Virtual health assistants should ensure an adequate knowledge base and ability to recognize intents and entities, include personality and spontaneity, and provide ongoing technical troubleshooting of the virtual assistant to ensure the assistant remains effective.

Due to the advance of indoor positioning technology, it is now possible to trace mobile medical equipment (such as electrocardiography machines, patient monitors, and so on) being moved around a hospital ward. With the support of an object tracking system, nurses can easily locate and find a device, especially when they prepare for a shift change or a medical treatment. As nurses usually face high workloads, it is highly desirable to provide nurses with a user-friendly search interface integrated into a popular mobile app that they use daily. For this, DBOS, a dialog-based object query system, is proposed, which simulates a real conversation with users via the Line messaging app&rsquo, s chatbot interface. A hybrid method that combines cosine similarity (CS) and term frequency&ndash, inverse document frequency (TF-IDF) is used to determine user intent. The result is returned to the user through Line&rsquo, s interface. To evaluate the applicability of DBOS, 70 search queries given by a head nurse were tested. DBOS was compared with CS, TF-IDF, and Facebook Wit.ai respectively. The experiment results show that DBOS outperforms the abovementioned methods and can achieve a 92.8% accuracy in identifying user intent.

Background The high demand for health care services and the growing capability of artificial intelligence have led to the development of conversational agents designed to support a variety of health-related activities, including behavior change, treatment support, health monitoring, training, triage, and screening support. Automation of these tasks could free clinicians to focus on more complex work and increase the accessibility to health care services for the public. An overarching assessment of the acceptability, usability, and effectiveness of these agents in health care is needed to collate the evidence so that future development can target areas for improvement and potential for sustainable adoption. Objective This systematic review aims to assess the effectiveness and usability of conversational agents in health care and identify the elements that users like and dislike to inform future research and development of these agents. Methods PubMed, Medline (Ovid), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and the Association for Computing Machinery Digital Library were systematically searched for articles published since 2008 that evaluated unconstrained natural language processing conversational agents used in health care. EndNote (version X9, Clarivate Analytics) reference management software was used for initial screening, and full-text screening was conducted by 1 reviewer. Data were extracted, and the risk of bias was assessed by one reviewer and validated by another. Results A total of 31 studies were selected and included a variety of conversational agents, including 14 chatbots (2 of which were voice chatbots), 6 embodied conversational agents (3 of which were interactive voice response calls, virtual patients, and speech recognition screening systems), 1 contextual question-answering agent, and 1 voice recognition triage system. Overall, the evidence reported was mostly positive or mixed. Usability and satisfaction performed well (27/30 and 26/31), and positive or mixed effectiveness was found in three-quarters of the studies (23/30). However, there were several limitations of the agents highlighted in specific qualitative feedback. Conclusions The studies generally reported positive or mixed evidence for the effectiveness, usability, and satisfactoriness of the conversational agents investigated, but qualitative user perceptions were more mixed. The quality of many of the studies was limited, and improved study design and reporting are necessary to more accurately evaluate the usefulness of the agents in health care and identify key areas for improvement. Further research should also analyze the cost-effectiveness, privacy, and security of the agents. International Registered Report Identifier (IRRID) RR2-10.2196/16934

Background Chatbots empowered by artificial intelligence (AI) can increasingly engage in natural conversations and build relationships with users. Applying AI chatbots to lifestyle modification programs is one of the promising areas to develop cost-effective and feasible behavior interventions to promote physical activity and a healthy diet. Objective The purposes of this perspective paper are to present a brief literature review of chatbot use in promoting physical activity and a healthy diet, describe the AI chatbot behavior change model our research team developed based on extensive interdisciplinary research, and discuss ethical principles and considerations. Methods We conducted a preliminary search of studies reporting chatbots for improving physical activity and/or diet in four databases in July 2020. We summarized the characteristics of the chatbot studies and reviewed recent developments in human-AI communication research and innovations in natural language processing. Based on the identified gaps and opportunities, as well as our own clinical and research experience and findings, we propose an AI chatbot behavior change model. Results Our review found a lack of understanding around theoretical guidance and practical recommendations on designing AI chatbots for lifestyle modification programs. The proposed AI chatbot behavior change model consists of the following four components to provide such guidance: (1) designing chatbot characteristics and understanding user background; (2) building relational capacity; (3) building persuasive conversational capacity; and (4) evaluating mechanisms and outcomes. The rationale and evidence supporting the design and evaluation choices for this model are presented in this paper. Conclusions As AI chatbots become increasingly integrated into various digital communications, our proposed theoretical framework is the first step to conceptualize the scope of utilization in health behavior change domains and to synthesize all possible dimensions of chatbot features to inform intervention design and evaluation. There is a need for more interdisciplinary work to continue developing AI techniques to improve a chatbot’s relational and persuasive capacities to change physical activity and diet behaviors with strong ethical principles.

Artificial Intelligence (AI) and its real-life applications are among the most effervescent research topics of the last couple of years. In the past decade, stakeholders such as private companies, public institutions, non-profit entities, and even individuals, have developed and used various AI algorithms to solve a wide range of problems. Given the extended applicability and the disruption potential of this technology, it was just a matter of time until it connected to the field of cultural heritage. This paper presents the development of an intelligent conversational agent which was built to improve the accessibility to information inside a history museum. We present the cultural context, the application architecture, the implementation challenges, and the visitors&rsquo, feedback. We created a smart virtual agent that interacts with users in natural spoken language. This involved the design and implementation of the artificial intelligence-based core responsible for understanding the Romanian language. A short survey regarding the tourist acceptance of the system was conducted at the premises of our partners, the Museum &ldquo, Casa Mureșenilor&rdquo, from Brașov, shows good acceptance levels from both visitors and museum staff. Given the flexibility of the implementation, the system can be used by a large array of stakeholders with minor modifications.

Google’s Duplex illustrates the great strides made in AI to provide synthetic agents the capabilities to intuitive and seemingly natural human- machine interaction, fostering a growing acceptance of AI systems as social actors. Following BJ Fogg’s captology framework, we analyse the persuasive and potentially manipulative power of emotionally intelligent conversational agents (EICAs). By definition, human-sounding conversational agents are ‘designed to deceive’. They do so on the basis of vast amounts of information about the individual they are interacting with. We argue that although the current data protection and privacy framework in the EU offers some protection against manipulative conversational agents, the real upcoming issues are not acknowledged in regulation yet.

This paper presents a user-centered approach to the design and evaluation of conversational search user interfaces to support the pilot in cockpits. Our findings of a controlled user experiment suggest that user perception of the usefulness of the system in completing the search task and the system's responses to the relevance of the topic are good predictors of search performance. User satisfaction with the system's responses may not be a good predictor of search performance in the context of safety of life scenarios such as cockpit procedures for pilots.

Recent technological advances introduced conversational agents into homes. Many researchers have investigated how people utilize and perceive them. However, only a small number of studies have focused on how older adults interact with these agents. This study presents a 14-day user study of 19 participants who experienced a conversational agent in a real-life environment. We grouped them into two groups by age and compared their experiences. From a log study and semi-structured interviews, we identified several differences between the two groups. Compared to younger adults, older adults used the agent more. They used it primarily for listening to music and reported satisfaction with it. Younger adults mainly used utility skills like weather report checks and setting of alarms, which streamlined their daily lives. Moreover, older adults tended to view the agent as a companion, while younger adults saw it as a tool. Based on these empirical findings, we suggest that conversational agents should be designed with consideration of the different usage patterns and perceptions across age groups.

The dramatic increment of communication impairments among children increases the demand for intensive, highly accessible and low-cost interventions as well as new assessment and therapeutic tools. Our research aims at exploring the use of Conversational Agents (CAs) to support linguistic assessment and training among children with language impairment. One of the open research issues in this arena concerns the identification of the most appropriate form of "embodiment" of the CA for children to interact with. To this end, we evaluated the linguistic performance of 14 neuro-typical children and 3 children with language impairment comparing different CAs - physical object and virtual character - with "traditional" human interaction. Based on our analysis, we identify insights for the design of CA: the physicality does influence the performance of linguistic tasks for children with linguistic impairment. In addition, children seem to show a preference for the physical CA and perceived it as smarter than the virtual one.

This demo presents TickTalkTurk, a tool that can assist task requesters in quickly deploying crowdsourcing tasks in a customizable conversational worker interface. The conversational worker interface can convey task instructions, deploy microtasks, and gather worker input in a dialogue-based workflow. The interface is implemented as a Web-based application, which makes it compatible with popular crowdsourcing platforms. The tool we developed is demonstrated through two microtask crowdsourcing examples with different task types. Results reveal that our conversational worker interface is capable of better engaging workers and analyzing workers performance.

Conversational agents are playing an increasingly important role in providing users with natural communication environments, improving outcomes in a variety of domains in human-computer interaction. Crowdsourcing marketplaces are simultaneously flourishing, and it has never been easier to acquire large-scale human input from online workers. Recent works have revealed the potential of conversational interfaces in improving worker engagement and satisfaction. At the same time, worker moods have been shown to have significant effects on quality related outcomes. Little is known about the role of worker moods in shaping work in conversational microtask crowdsourcing. In this paper, we conducted a crowdsourcing study addressing 600 unique online workers, to investigate the role that worker moods play in conversational microtask crowdsourcing. We also explore whether suitable conversational styles of the agent can affect the performance of workers in different moods. Our results show that workers in a pleasant mood tend to produce significantly higher quality results (over 20%), exhibit greater engagement (an increase by around 19%) and report a lower cognitive load (by over 12%), and a suitable conversational style can have a significant impact on workers in different moods. Our findings advance the current understanding of conversational microtask crowdsourcing and have important implications on designing future conversational crowdsourcing systems.

Background This protocol describes a study that will test the effectiveness of a 10-week non-clinical psychological coaching intervention for intentional personality change using a smartphone application. The goal of the intervention is to coach individuals who are willing and motivated to change some aspects of their personality, i.e., the Big Five personality traits. The intervention is based on empirically derived general change mechanisms from psychotherapy process-outcome research. It uses the smartphone application PEACH (PErsonality coACH) to allow for a scalable assessment and tailored interventions in the everyday life of participants. A conversational agent will be used as a digital coach to support participants to achieve their personality change goals. The goal of the study is to examine the effectiveness of the intervention at post-test assessment and three-month follow-up. Methods/Design A 2x2 factorial between-subject randomized, wait-list controlled trial with intensive longitudinal methods will be conducted to examine the effectiveness of the intervention. Participants will be randomized to one of four conditions. One experimental condition includes a conversational agent with high self-awareness to deliver the coaching program. The other experimental condition includes a conversational agent with low self-awareness. Two wait-list conditions refer to the same two experimental conditions, albeit with four weeks without intervention at the beginning of the study. The 10-week intervention includes different types of micro-interventions: (a) individualized implementation intentions, (b) psychoeducation, (c) behavioral activation tasks, (d) self-reflection, (e) resource activation, and (f) individualized progress feedback. Study participants will be at least 900 German-speaking adults (18 years and older) who install the PEACH application on their smartphones, give their informed consent, pass the screening assessment, take part in the pre-test assessment and are motivated to change or modify some aspects of their personality. Discussion This is the first study testing the effectiveness of a smartphone- and conversational agent-based coaching intervention for intended personality change. Given that this novel intervention approach proves effective, it could be implemented in various non-clinical settings and could reach large numbers of people due to its low-threshold character and technical scalability. ISSN:2050-7283

BackgroundIn the United States and parts of the world, the human papillomavirus vaccine uptake is below the prescribed coverage rate for the population. Some research have noted that dialogue that communicates the risks and benefits, as well as patient concerns, can improve the uptake levels. In this paper, we introduce an application ontology for health information dialogue called Patient Health Information Dialogue Ontology for patient-level human papillomavirus vaccine counseling and potentially for any health-related counseling.ResultsThe ontology’s class level hierarchy is segmented into 4 basic levels -Discussion,Goal,Utterance, andSpeech Task. The ontology also defines core low-level utterance interaction for communicating human papillomavirus health information. We discuss the design of the ontology and the execution of the utterance interaction.ConclusionWith an ontology that represents patient-centric dialogue to communicate health information, we have an application-driven model that formalizes the structure for the communication of health information, and a reusable scaffold that can be integrated for software agents. Our next step will to be develop the software engine that will utilize the ontology and automate the dialogue interaction of a software agent.

BackgroundRegular physical activity (PA) is crucial for well-being; however, healthy habits are difficult to create and maintain. Interventions delivered via conversational agents (eg, chatbots or virtual agents) are a novel and potentially accessible way to promote PA. Thus, it is important to understand the evolving landscape of research that uses conversational agents.ObjectiveThis mixed methods systematic review aims to summarize the usability and effectiveness of conversational agents in promoting PA, describe common theories and intervention components used, and identify areas for further development.MethodsWe conducted a mixed methods systematic review. We searched seven electronic databases (PsycINFO, PubMed, Embase, CINAHL, ACM Digital Library, Scopus, and Web of Science) for quantitative, qualitative, and mixed methods studies that conveyed primary research on automated conversational agents designed to increase PA. The studies were independently screened, and their methodological quality was assessed using the Mixed Methods Appraisal Tool by 2 reviewers. Data on intervention impact and effectiveness, treatment characteristics, and challenges were extracted and analyzed using parallel-results convergent synthesis and narrative summary.ResultsIn total, 255 studies were identified, 7.8% (20) of which met our inclusion criteria. The methodological quality of the studies was varied. Overall, conversational agents had moderate usability and feasibility. Those that were evaluated through randomized controlled trials were found to be effective in promoting PA. Common challenges facing interventions were repetitive program content, high attrition, technical issues, and safety and privacy concerns.ConclusionsConversational agents hold promise for PA interventions. However, there is a lack of rigorous research on long-term intervention effectiveness and patient safety. Future interventions should be based on evidence-informed theories and treatment approaches and should address users’ desires for program variety, natural language processing, delivery via mobile devices, and safety and privacy concerns.

Background Conversational agents or chatbots are computer programs that simulate conversations with users. Conversational agents are increasingly used for delivery of behavior change interventions in health care. Behavior change is complex and comprises the use of one or several components collectively known as behavioral change techniques (BCTs). Objective The objective of this scoping review is to identify the BCTs that are used in behavior change–focused interventions delivered via conversational agents in health care. Methods This scoping review will be performed in line with the Joanna Briggs Institute methodology and will be reported according to the PRISMA extension for scoping reviews guidelines. We will perform a comprehensive search of electronic databases and grey literature sources, and will check the reference lists of included studies for additional relevant studies. The screening and data extraction will be performed independently and in parallel by two review authors. Discrepancies will be resolved through consensus or discussion with a third review author. We will use a data extraction form congruent with the key themes and aims of this scoping review. BCTs employed in the included studies will be coded in line with BCT Taxonomy v1. We will analyze the data qualitatively and present it in diagrammatic or tabular form, alongside a narrative summary. Results To date, we have designed the search strategy and performed the search on April 26, 2021. The first round of screening of retrieved articles is planned to begin soon. Conclusions Using appropriate BCTs in the design and delivery of health care interventions via conversational agents is essential to improve long-term outcomes. Our findings will serve to inform the development of future interventions in this area. International Registered Report Identifier (IRRID) PRR1-10.2196/30166

Digital family health history tools have been developed but few have been tested with non-English speakers and evaluated for acceptability and usability. This study describes the cultural and linguistic adaptation and evaluation of a family health history tool (VICKY: VIrtual Counselor for Knowing Your Family History) for Spanish speakers. In-depth interviews were conducted with 56 Spanish-speaking participants, a subset of 30 also participated in a qualitative component to evaluate the acceptability and usability of Spanish VICKY. Overall, agreement in family history assessment was moderate between VICKY and a genetic counselor (weighted kappa range: 0.4695 for stroke&mdash, 0.6615 for heart disease), although this varied across disease subtypes. Participants felt comfortable using VICKY and noted that VICKY was very likeable and possessed human-like characteristics. They reported that VICKY was very easy to navigate, felt that the instructions were very clear, and thought that the time it took to use the tool was just right. Spanish VICKY may be useful as a tool to collect family health history and was viewed as acceptable and usable. The study results shed light on some cultural differences that may influence interactions with family history tools and inform future research aimed at designing and testing culturally and linguistically diverse digital systems.

Background Conversational agents (also known as chatbots) have evolved in recent decades to become multimodal, multifunctional platforms with potential to automate a diverse range of health-related activities supporting the general public, patients, and physicians. Multiple studies have reported the development of these agents, and recent systematic reviews have described the scope of use of conversational agents in health care. However, there is scarce research on the effectiveness of these systems; thus, their viability and applicability are unclear. Objective The objective of this systematic review is to assess the effectiveness of conversational agents in health care and to identify limitations, adverse events, and areas for future investigation of these agents. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols will be used to structure this protocol. The focus of the systematic review is guided by a population, intervention, comparator, and outcome framework. A systematic search of the PubMed (Medline), EMBASE, CINAHL, and Web of Science databases will be conducted. Two authors will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardized form and conduct quality appraisal. Results As of January 2020, we have begun a preliminary literature search and piloting of the study selection process. Conclusions This systematic review aims to clarify the effectiveness, limitations, and future applications of conversational agents in health care. Our findings may be useful to inform the future development of conversational agents and promote the personalization of patient care. International Registered Report Identifier (IRRID) PRR1-10.2196/16934

Difference in features of voice such as tone, volume, intonation, and rate of speech have been suggested as sensitive and valid measures of mental illness. Researchers have used analysis of voice recordings during phone calls, response to the IVR systems and smartphone based conversational agents as a marker in continuous monitoring of symptoms and effect of treatment in patients with mental illness. While these methods of recording the patient’s voice have been considered efficient, they come with a number of issues in terms of adoption, privacy, security, data storage etc. To address these issues we propose a smart speaker based conversational agent – “Hear me out”. In this paper, we describe the proposed system, rationale behind using smart speakers, and the challenges we are facing in the design of the system.

[Context] Digital transformation impacts an ever-increasing degree of everyone’s business and private life. It is imperative to incorporate a wide audience of user requirements in the development process to design successful information systems (IS). Hence, requirements elicitation (RE) is increasingly performed by end-users that are novices at contributing requirements to IS development projects. [Objective] We need to develop RE systems that are capable of assisting a wide audience of end-users in communicating their needs and requirements. Prominent methods, such as elicitation interviews, are challenging to apply in such a context, as time and location constraints limit potential audiences. [Research Method] The presented dissertation project utilizes design science research to develop a requirements self-elicitation system, LadderBot. A conversational agent (CA) enables end-users to articulate needs and requirements on the grounds of the laddering method. The CA mimics a human interviewer’s capability to rephrase questions and provide assistance in the process and allows users to converse in their natural language. Furthermore, the tool will assist requirements analysts with the subsequent aggregation and analysis of collected data. [Contribution] The dissertation project makes a practical contribution in the form of a ready-to-use system for wide audience end-user RE and subsequent analysis utilizing laddering as cognitive elicitation technique. A theoretical contribution is provided by developing a design theory for the application of conversational agents for RE, including the laboratory and field evaluation of design principles.

As the uses of conversational agents increase, the affective and social abilities of agents become important with their functional abilities. Agents that lack affective abilities could frustrate users during interaction. This study applied personality to implement the natural feedback of conversational agents referring to the concept of affective computing. Two types of feedback were used to express conversational agents&rsquo, personality: (1) visual feedback and (2) verbal cues. For visual feedback, participants (N = 45) watched visual feedback with different colors and motions. For verbal cues, participants (N = 60) heard different conditions of agents&rsquo, voices with different scripts. The results indicated that the motions of visual feedback were more significant than colors. Fast motions could express distinct and positive personalities. Different verbal cues were perceived as different personalities. The perceptions of personalities differed according to the vocal gender. This study provided design implications for personality expressions applicable to diverse interfaces.

Highlights • Chatbots are artificial intelligence–driven programs that interact with people. • They can be used for screening, treatment adherence and follow-up. • They can be deployed as text-based services on a website or mobile applications. • Potential applications are very promising in our field., Chatbots, also known as conversational agents or digital assistants, are artificial intelligence–driven software programs designed to interact with people in a conversational manner. They are often used for user-friendly customer-service triaging. In healthcare, chatbots can create bidirectional information exchange with patients, which could be leveraged for follow-up, screening, treatment adherence or data-collection. They can be deployed over various modalities, such as text-based services (text messaging, mobile applications, chat rooms) on any website or mobile applications, or audio services, such as Siri, Alexa, Cortana or Google Assistant. Potential applications are very promising, particularly in the field of oncology. In this review, we discuss the available publications and applications and the ongoing trials in that setting.

Background: Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on an individual’s levels of emotional distress, health outcomes, and associated health care utilization. As health care services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent (chatbot, conversational agent), which uses artificial intelligence (AI) to process the user’s written or spoken natural language and then to select or construct the corresponding appropriate responses. Objective: This study aimed to co-design the content, functionality, and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (LTC; chronic pulmonary obstructive disease [COPD]) and then to assess the acceptability and system content. Methods: We conducted 2 co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care. Results: Adults (n=6) with a diagnosis of COPD and health professionals (n=5) specified 4 priority self-management scenarios for which they would like to receive support: at the time of diagnosis (information provision), during acute exacerbations (crisis support), during periods of low mood (emotional support), and for general self-management (motivation). From the scenario testing, 12 additional adults with COPD felt the system to be both acceptable and engaging, particularly with regard to internet-of-things capabilities. They felt the system would be particularly useful for individuals living alone. Conclusions: Patients did not explicitly separate mental and physical health needs, although the content they developed for the virtual agent had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs.

Over the last decade, there has been an explosion of digital interventions that aim to either supplement or replace face-to-face mental health services. More recently, a number of automated conversational agents have also been made available, which respond to users in ways that mirror a real-life interaction. What are the social and ethical concerns that arise from these advances? In this article, we discuss, from a young person’s perspective, the strengths and limitations of using chatbots in mental health support. We also outline what we consider to be minimum ethical standards for these platforms, including issues surrounding privacy and confidentiality, efficacy, and safety, and review three existing platforms (Woebot, Joy, and Wysa) according to our proposed framework. It is our hope that this article will stimulate ethical debate among app developers, practitioners, young people, and other stakeholders, and inspire ethically responsible practice in digital mental health.

A chatbot is an example of a text-based conversational agent. While natural language understanding and machine learning techniques have advanced rapidly, current fully automated chatbots still struggle to serve their users well. Human intelligence, brought by crowd workers, freelancers, or even full-time employees can be embodied in the chatbot logic to fill the gaps caused by limitations of fully automated solutions. In this paper, we investigate human-aided bots, i.e., bots (including chatbots) using humans in the loop to operate. We survey industrial and academic examples of human-aided bots, discuss their differences and common patterns, and identify open research questions.

The effect of digital transformation in organizations needs to go beyond automation, so that human capabilities are also augmented. A possibility in this direction is to make formal representations of processes more accessible for the actors involved. On this line, this paper presents a methodology to transform a formal process description into a conversational agent, which can guide a process actor through the required steps in a user-friendly conversation. The presented system relies on dialog systems and natural language processing and generation techniques, to automatically build a chatbot from a process model. A prototype tool – accessible online – has been developed to transform a process model in BPMN into a chatbot, defined in Artificial Intelligence Marking Language (AIML), which has been evaluated over academic and industrial professionals, showing potential into improving the gap between process understanding and execution.

Artificial intelligence–driven voice technology deployed on mobile phones and smart speakers has the potential to improve patient management and organizational workflow. Voice chatbots have been already implemented in health care–leveraging innovative telehealth solutions during the COVID-19 pandemic. They allow for automatic acute care triaging and chronic disease management, including remote monitoring, preventive care, patient intake, and referral assistance. This paper focuses on the current clinical needs and applications of artificial intelligence–driven voice chatbots to drive operational effectiveness and improve patient experience and outcomes.

E-learning systems based on a conversational agent provide the basis of an intuitive, responsive, engaging interface for the online learner. This paper proposes an approach to intelligent intervention and strategic pedagogical design for improving student engagement when chatting with a conversational agent. First, we used previous conversational logs to detect and classify interaction behaviors of learners. And then we designed a set of strategies for intelligent intervention to improve learners’ engagement when conversing with the conversational agents. We implemented a multiagent framework to apply the strategy-based intervention. The effectiveness of learner interaction behaviors and the impact of intelligent intervention by the conversational agent were evaluated through chatlog analysis. Although not all of the quantitative tests were sensitive enough to detect the effect of the interventions, the findings suggest that the detection of behaviours was accurate. The interventions were observed to have the desired effect on behaviours associated with conversational engagement.

Human-computer interaction is progressively shifting towards natural language communication, determining the rise of conversational agents. In the context of ubiquitous computing, the opportunities for interacting with new services and systems in a conversational manner are increasing and, nowadays, it is common to talk to home assistants to interact with a smart environment or to write to chatbots to access an online service. This workshop aims at bringing together researchers from academia and industry in order to establish a multidisciplinary community interested in discovering and exploring the challenges and opportunities coming from the ubiquity of conversational agents.

Hundreds of well-being apps aim to manage stress. Despite some successes in developing personalized regimes for stress coaching, current apps are still far from offering a compelling user experience. We discuss the requirements and technical challenges underlying the design of a virtual coach, including the critical need to support both personalization and conversation.

This paper presents the colMOOC project perspective for integrating a conversational agent service in Massive Open Online Courses (MOOCs) to facilitate peer dialogue during chat-based activities. Furthermore, it provides high level system architecture to highlight key aspects of the technology infrastructure and the functionality of the software system. The rationale of the approach follows the tenets of several converging theoretical perspectives emphasizing the value of learners' dialogue and constructive argumentation as knowledge building processes during collaborative activities. The MOOC teacher (domain expert) is expected to play a key role by entering in the system conceptual links that guide the agent to make relevant questioning interventions. Thus, the agent tool is mediating group-teacher interactions in a MOOC environment aiming to increase the transactive quality of peer dialogue. The paper discusses also the 'Academically Productive Talk' model that provides the basis for the agent interventions and the major software components of the system, including the colMOOC Editor and the colMOOC Player.

Disclosing personal information to another person has beneficial emotional, relational, and psychological outcomes. When disclosers believe they are interacting with a computer instead of another person, such as a chatbot that can simulate human-to-human conversation, outcomes may be undermined, enhanced, or equivalent. Our experiment examined downstream effects after emotional versus factual disclosures in conversations with a supposed chatbot or person. The effects of emotional disclosure were equivalent whether participants thought they were disclosing to a chatbot or to a person. This study advances current understanding of disclosure and whether its impact is altered by technology, providing support for media equivalency as a primary mechanism for the consequences of disclosing to a chatbot.