Post-traumatic stress disorder (PTSD) is a serious public health issue. Approximately 8 million adults in the United States suffer from PTSD in any given year, and 7–8% of the U.S. population will have PTSD at some point in their lives. Recent studies have explored eHealth technologies to support persons living with PTSD. However, current approaches are often unable to sustain adherence, leading to sub-optimal clinical outcomes. Conversational agents (CAs) can help to improve longitudinal adherence by interactively engaging users and maintaining social presence. In this work, we present prototypes of PTSDialogue — a finite-state CA to deliver evidence-based strategies and support self-management for individuals living with PTSD. We also discuss the design requirements and process of adapting existing eHealth content to interactive dialogues. Furthermore, we detail design decisions to address safety and ethical concerns to develop a CA for a vulnerable population.
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Preliminary Evaluation of a Conversational Agent to Support Self-management of Individuals Living With Posttraumatic Stress Disorder: Interview Study With Clinical Experts
Posttraumatic stress disorder (PTSD) is a serious public health concern. However, individuals with PTSD often do not have access to adequate treatment. A conversational agent (CA) can help to bridge the treatment gap by providing interactive and timely interventions at scale. Toward this goal, we have developed PTSDialogue—a CA to support the self-management of individuals living with PTSD. PTSDialogue is designed to be highly interactive (eg, brief questions, ability to specify preferences, and quick turn-taking) and supports social presence to promote user engagement and sustain adherence. It includes a range of support features, including psychoeducation, assessment tools, and several symptom management tools.
This paper focuses on the preliminary evaluation of PTSDialogue from clinical experts. Given that PTSDialogue focuses on a vulnerable population, it is critical to establish its usability and acceptance with clinical experts before deployment. Expert feedback is also important to ensure user safety and effective risk management in CAs aiming to support individuals living with PTSD.
We conducted remote, one-on-one, semistructured interviews with clinical experts (N=10) to gather insight into the use of CAs. All participants have completed their doctoral degrees and have prior experience in PTSD care. The web-based PTSDialogue prototype was then shared with the participant so that they could interact with different functionalities and features. We encouraged them to “think aloud” as they interacted with the prototype. Participants also shared their screens throughout the interaction session. A semistructured interview script was also used to gather insights and feedback from the participants. The sample size is consistent with that of prior works. We analyzed interview data using a qualitative interpretivist approach resulting in a bottom-up thematic analysis.
Our data establish the feasibility and acceptance of PTSDialogue, a supportive tool for individuals with PTSD. Most participants agreed that PTSDialogue could be useful for supporting self-management of individuals with PTSD. We have also assessed how features, functionalities, and interactions in PTSDialogue can support different self-management needs and strategies for this population. These data were then used to identify design requirements and guidelines for a CA aiming to support individuals with PTSD. Experts specifically noted the importance of empathetic and tailored CA interactions for effective PTSD self-management. They also suggested steps to ensure safe and engaging interactions with PTSDialogue.
Based on interviews with experts, we have provided design recommendations for future CAs aiming to support vulnerable populations. The study suggests that well-designed CAs have the potential to reshape effective intervention delivery and help address the treatment gap in mental health.
- Award ID(s):
- 1850287
- NSF-PAR ID:
- 10475892
- Editor(s):
- A Mavragani
- Publisher / Repository:
- JMIR Formative Research
- Date Published:
- Journal Name:
- JMIR Formative Research
- Volume:
- 7
- ISSN:
- 2561-326X
- Page Range / eLocation ID:
- e45894
- Subject(s) / Keyword(s):
- ["conversational agent","PTSD","self-management","clinical experts","evaluation","support system","mental health","trauma"]
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.2196/45894
