Co-designing and testing the acceptability of a virtual agent to support self-management for individuals living with physical and mental comorbidities

Background: Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on individual’s levels of emotional distress, health outcomes and associated healthcare utilization. As healthcare 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. Objective: 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 (Chronic Pulmonary Obstructive Disease, COPD), and then to assess the acceptability and system content. Methods: We conducted two 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 four priority self-management scenarios for which they would like to receive support: at time of diagnosis (information provision); during acute exacerbations (crisis support); during periods of low mood (emotional support); and for general self-management (motivation). Based on the scenario testing, 12 additional adults with COPD felt the system was both acceptable and engaging, particularly with respect to internet of things capabilities. They felt the system would be particularly useful for individuals living alone. Conclusions: Patients did not explicitly separate out mental and physical health needs, although the content they developed for Avachat 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 long term conditions.