Development and Evaluation of a Relational Agent to Assist with Screening and Intervention for Unhealthy Drinking in Primary Care

Screening, brief intervention, and referral for alcohol misuse during primary care appointments is recommended to address high rates of unhealthy alcohol use. However, implementation of screening and referral practices into primary care remains difficult. Computerized Relational Agents programmed to provide alcohol screening, brief intervention, and referral can effectively reduce the burden on clinical staff by increasing screening practices. As part of a larger clinical trial, we aimed to solicit input from patients about the design and development of a Relational Agent for alcohol brief intervention. We also solicited input from patients who interacted with the implemented version of the Relational Agent intervention after they finished the trial. A two-part development and evaluation study was conducted. To begin, a user-centered design approach was used to customize the intervention for the population served. A total of 19 participants shared their preferences on the appearance, setting, and preferences of multiple Relational Agents through semi-structured interviews. Following the completion of the study one interviews, a Relational Agent was chosen and refined for use in the intervention. In study two, twenty participants who participated in the clinical trial intervention were invited back to participate in a semi-structured interview to provide feedback about their experiences in interacting with the intervention. Study one results showed that participants preferred a female Relational Agent located in an office-like setting, but the mechanical and still movements of the Relational agent decreased feelings of authenticity and human trustworthiness for participants. After refinements to the Relational Agent, post-intervention results in study two showed that participants ( n = 17, 89%) felt comfortable interacting and discussing their drinking habits with the Relational Agent and participants ( n = 10, 53%) believed that the intervention had a positive impact on the way participants thought about drinking or on their actual drinking habits. Despite variability in the preferences of participants during the development stage of the intervention, incorporating the feedback of participants during the design process resulted in optimized comfort levels for individuals interacting with the Relational Agent. clinicaltrials.gov, NCT02030288, https://clinicaltrials.gov/ct2/home