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Keeping users engaged with mHealth applications is important but difficult to achieve. We describe the development of a smartphone-based application designed to promote health and wellness in church communities, along with mechanisms explicitly designed to maintain engagement. We evaluated religiously tailored techno-spiritual engagement mechanisms, including a prayer posting wall, pastor announcements, an embodied conversational agent for dialogue-based scriptural reflections and health coaching, and tailored push notifications. We conducted a four-week pilot study with 25 participants from two churches, measuring high levels of participant acceptance and satisfaction with all features of the application. Engagement with the app was higher for users considered to be more religious and correlated with the number of notifications received. Our findings demonstrate that our tailored mechanisms can increase engagement with an mHealth app 

Embodied conversational agents (ECAs) provide an interface modality on smartphones that may be particularly effective for tasks with significant social, affective, reflective, and narrative aspects, such as health education and behavior change counseling. However, the conversational medium is significantly slower than conventional graphical user interfaces (GUIs) for brief, time-sensitive tasks. We conducted a randomized experiment to determine user preferences in performing two kinds of health-related tasks—one affective and narrative in nature and one transactional—and gave participants a choice of a conventional GUI or a functionally equivalent ECA on a smartphone to complete the task. We found significant main effects of task type and user preference on user choice of modality, with participants choosing the conventional GUI more often for transactional and time-sensitive tasks. 

Culturally informed design for virtual agents has been shown to positively impact health outcomes when tailored to target audiences. We present a participatory design methodology for culturally tailoring virtual agents. Investigators worked with key informants from our target population, members of predominantly Black church communities, to design culturally-relevant and sensitive virtual agent health promotion interventions. In the first participatory session, key informants designed agents to assist them with different aspects of their lives, providing input on agent appearance and agent functionality. In a second design session, participants re-wrote the content of a health conversation with an agent, to include personally-relevant content related to their community (e.g., religious and scriptural references). We report design principles for religious tailoring derived from these studies. We conducted a validation study to assess the effects of applying these principles to agents that promoted two health behaviors, finding that participants responded very positively to the tailored agents. 

Churches play a major role in providing social support to address health inequities within Black communities, in part by connecting members to key organizations and services. While public health has a history of disseminating interventions in faith communities, little work has explored the use of crowdsourcing to tailor interventions to the unique culture of each church community. Following Community Based Participatory Research principles, we partnered with two predominantly Black churches, and report on a series of three participatory design sessions with nine participants. We developed a novel storyboarding method to explore how crowdsourcing could promote health in these faith-based communities. Our findings characterize existing supports within the church community, and how church social structures impact member access to these supports. We further identify motivations to engage with a church-situated health application, and how these motivations translate to crowdsourcing tasks. Finally, we discuss considerations for public health crowdsourcing tasks.