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HCI researchers have increasingly examined how social context shapes health behaviors. Much of this work operates at the interpersonal level. Communities such as churches play important roles in supporting wellbeing and addressing health inequities. While some work has investigated creating digital health tools for religious populations, few have explicitly focused on the incorporation of community support in the form of prayer support. Embedding health interventions in any community has the potential to support or challenge the community’s dynamics. We report on findings from interviews with 17 church members who used a church-based mHealth application over a 4-week period and provide guidelines for developers based on these results. Through their use of the system, participants characterized several community dynamics including a desire for social intimacy, communicating care, creating opportunities for fellowship, maintaining privacy and discretion, and building community connections, and how these dynamics influence their aspirations for a church-based health app. 

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.