Self-Guided Web-Based Interventions: Scoping Review on User Needs and the Potential of Embodied Conversational Agents to Address Them.
J Med Internet Res. 2017 Nov 16;19(11):e383
Authors: Scholten MR, Kelders SM, Van Gemert-Pijnen JE
BACKGROUND: Web-based mental health interventions have evolved from innovative prototypes to evidence-based and clinically applied solutions for mental diseases such as depression and anxiety. Open-access, self-guided types of these solutions hold the promise of reaching and treating a large population at a reasonable cost. However, a considerable factor that currently hinders the effectiveness of these self-guided Web-based interventions is the high level of nonadherence. The absence of a human caregiver apparently has a negative effect on user adherence. It is unknown to what extent this human support can be handed over to the technology of the intervention to mitigate this negative effect.
OBJECTIVE: The first objective of this paper was to explore what is known in literature about what support a user needs to stay motivated and engaged in an electronic health (eHealth) intervention that requires repeated use. The second objective was to explore the current potential of embodied conversational agents (ECAs) to provide this support.
METHODS: This study reviews and interprets the available literature on (1) support within eHealth interventions that require repeated use and (2) the potential of ECAs by means of a scoping review. The rationale for choosing a scoping review is that the subject is broad, diverse, and largely unexplored. Themes for (1) and (2) were proposed based on grounded theory and mapped on each other to find relationships.
RESULTS: The results of the first part of this study suggest the presence of user needs that largely remain implicit and unaddressed. These support needs can be categorized as task-related support and emotion-related support. The results of the second part of this study suggest that ECAs are capable of engaging and motivating users of information technology applications in the domains of learning and behavioral change. Longitudinal studies must be conducted to determine under what circumstances ECAs can create and maintain a productive user relationship. Mapping the user needs on the ECAs' capabilities suggests that different kinds of ECAs may provide different solutions for improving the adherence levels.
CONCLUSIONS: Autonomous ECAs that do not respond to a user's expressed emotion in real time but take on empathic roles may be sufficient to motivate users to some extent. It is unclear whether those types of ECAs are competent enough and create sufficient believability among users to address the user's deeper needs for support and empathy. Responsive ECAs may offer a better solution. However, at present, most of these ECAs have difficulties to assess a user's emotional state in real time during an open dialogue. By conducting future research with relationship theory-based ECAs, the added value of ECAs toward user needs can be better understood.
PMID: 29146567 [PubMed - in process]
Teacher factors contributing to dosage of the KiVa anti-bullying program.
J Sch Psychol. 2017 Dec;65:102-115
Authors: Swift LE, Hubbard JA, Bookhout MK, Grassetti SN, Smith MA, Morrow MT
The KiVa Anti-Bullying Program (KiVa) seeks to meet the growing need for anti-bullying programming through a school-based, teacher-led intervention for elementary school children. The goals of this study were to examine how intervention dosage impacts outcomes of KiVa and how teacher factors influence dosage. Participants included 74 teachers and 1409 4th- and 5th-grade students in nine elementary schools. Teachers and students completed data collection at the beginning and end of the school year, including measures of bullying and victimization, correlates of victimization (depression, anxiety, peer rejection, withdrawal, and school avoidance), intervention cognitions/emotions (anti-bullying attitudes, and empathy toward victims), bystander behaviors, and teacher factors thought to relate to dosage (self-efficacy for teaching, professional burnout, perceived principal support, expected effectiveness of KiVa, perceived feasibility of KiVa). The dosage of KiVa delivered to classrooms was measured throughout the school year. Results highlight dosage as an important predictor of change in bullying, victimization, correlates of victimization, bystander behavior, and intervention cognitions/emotions. Of the teacher factors, professional burnout uniquely predicted intervention dosage. A comprehensive structural equation model linking professional burnout to dosage and then to child-level outcomes demonstrated good fit. Implications for intervention design and implementation are discussed.
PMID: 29145938 [PubMed - in process]
Defending victims: What does it take to intervene in bullying and how is it rewarded by peers?
J Sch Psychol. 2017 Dec;65:1-10
Authors: van der Ploeg R, Kretschmer T, Salmivalli C, Veenstra R
Defending is considered important in reducing bullying and victimization in schools. Yet, the prevalence of defending is quite low and there is little insight into aspects that explain why students intervene in bullying situations. The current study used a longitudinal design to simultaneously examine the antecedents and status outcomes of defending behavior. It was expected that affective and social-cognitive factors explain involvement in defending. Moreover, it was proposed that defending would be rewarded with popularity among peers, but only for defenders who were not victimized themselves. Unconflated multilevel path models were used and data came from students in grades 4-6 of Finnish elementary schools (N=4209 students from 210 classrooms and 38 schools; Mage 11.25; 50% boys). Affective empathy and students' self-efficacy beliefs were predictive of defending behavior over time, whereas cognitive empathy was not. Additionally, defenders increased their popularity among their peers. No substantial differences between victims and non-victims were found. This pattern of results suggests that, irrespective of victim status, specific children are more likely to defend in bullying situations and are rewarded with increased popularity.
PMID: 29145937 [PubMed - in process]
Short-Term Effects of the Empathic Talk: The Role of Perceived Empathy, Interpersonal Dispositions, and Vagal Tone on Experiencing Depth.
Span J Psychol. 2017 Nov 17;20:E61
Authors: Dufey M, Wilson JE
The present study examines the immediate impact of empathic attitudes on the receiver, by comparing an empathic conversation (EC) with a neutral one (NC) on experiencing depth (EXP), perceived empathy and vagal tone. We also evaluate if empathy effects depend on personality dispositions relevant to interpersonal functioning. An experimental, counterbalanced, within-subject design was implemented wherein participants (n = 27, age M = 22.6, SD = 4.0, 52% females) talked about a personal, meaningful topic for 20 minutes under both the EC and NC conditions. At the group level, main results indicated that the EC was more effective than the NC in promoting increases in EXP over time (F(1, 25) = 21.04, p < .001, η p 2 = .457) and perceived empathy in women (F(1, 25) = 9.42, p = .005, η p 2 = .264). At the individual level, the NC particularly precluded EXP gains in people expressing a better interpersonal functioning (βs < -.46, ps < .05 for attachment security and empathy and β = .38, p < .05 for aggression), and who also inhibited their vagal tone throughout this very condition (β = .40, p = .024). We conclude that the empathic context has an immediate positive impact on healthy psychological variables, whereas a more impersonal setting would drive people away from this positive effect. Those results are discussed in the light of the role of interpersonal proximity (being empathic to another's experience and the lack of this attitude) in psychotherapy and healthy functioning.
PMID: 29145917 [PubMed - in process]
Changes in Empathy during Medical Education: An Example from Turkey.
Pak J Med Sci. 2017 Sep-Oct;33(5):1177-1181
Authors: Igde FA, Sahin MK
Objective: Empathy is a key element of patient- physician communication; it is relevant to and positively influences patients' health. In this study we aimed to present the Turkey example for the empathy change during the medical faculty training.
Methods: This cross-sectional study was carried out at Ondokuz Mayis University, Faculty of Medicine, Department of Family Medicine, Samsun, Turkey. in first three years students of medicine during September 2014 to June 2015. Turkish adapted form of the student version of Jefferson empathy scale and sociodemographic questionnaire was used and data was assessed with the SPSS program.
Results: Total 511 students (52.5% female, 47.5% male), from first three years of medical faculty participated in the study. Two hundred thirty three (44.5%) students were from the First Year class, while 130 (27.1%) and 148 (28.4%) of them were from Second and Third Year respectively. The mean age was 20.63±2.73 years. Significant differences in the empathy scores were observed among first three years in medical school as like as between gender.
Conclusion: Although medical schools tend to raise students with higher empathy levels, medical education itself is more scientific based than humanistic approach, and makes medical students more tough and insensitive to the problems of patients. Patient-centered approach and empathy training should be implemented in the curriculum during whole medical education.
PMID: 29142560 [PubMed]