mHealth Improves Patient Engagement

Conversational messaging tools improve healthy behavior and boost patient outcomes.

Online health tools and applications are effective at communicating healthy behaviors, and can lead to much healthier lifestyles. Mobile health platforms (mHealth) in particular have been targeted by providers as a means to boost the treatment for a number of conditions.

However, new research published by Human Communication Research shows that a conversational tone used by these programs could lull patients into a false sense of comfort.

"This shows that delivering information on health risks through dialogue can help users get engaged with the tool and may positively affect their health," said researcher S. Shyam Sundar, PhD. "In general, it speaks to the design of interactive delivery of health information that it is not only engaging, but also inspiring."

The study authors discovered that interconnected questions and answers can promote feelings of contingency, and increase engagement with the program. In turn, this can improve the likelihood that the user will adopt the outlined strategies to improve health, according to the study.

"When you are having this back and forth interaction with a system -- you are having a conversation with that system," Dr Sundar said. "We think that interactivity has been achieved when the system's output is contingent on the user's input in a continuous threaded way."

While a back and forth conversation may improve health intentions, the investigators discovered that a conversational tone could make users feel less susceptible to obesity, diabetes, and heart disease. When the online tool used informal, short phrases such as “Mm-hmm” and “Go on,” patients felt less susceptible to serious health risks, according to the study.

"This conversational tone may make them warm and fuzzy, but that's not what you want to do with a health assessment tool," said researcher Saraswathi Bellur, PhD. "If you want people to stand up and take action, this type of friendly turn-taking softens the effect. However, if the goal of the interaction is to promote a sense of comfort among individuals, the same conversational tone strategy could work well, with the online tool acting like a virtual coach and providing reassurance.”

The study authors believe that as more Americans become frustrated with face-to-face interactions with their physicians, they may be more open to online tools and applications to improve overall health.

"We are seeing a growth in e-medicine," Dr Sundar said. "People are trying to compensate for this lack of face-to-face time with doctors by using online tools, which are becoming increasingly conversational."

While many of these tools tend to be sophisticated, the study authors said they may not need to be. They discovered that instant messaging may effectively improve the practice of healthy behaviors.

Included in the study were 172 college-age students who were assigned 1 of 6 versions of a health assessment website designed to have low, medium, or high interactivity with or without a conversational tone. Participants responded to questions through instant messaging to determine health risks.

The low-interactivity site did not display signs or cues that there was continuous interaction, while the medium-interactivity site displayed the user’s response as “Your Response,” according to the study. In the high-interactivity site, the program referred to previous answers when responding.

The researchers reported that conversational tools included phrases such as, "Let's move onto the next question" and "OK, let's talk about exercise.”

While the use of these tools is increasing, it is still important to engage in physician visits, and understand health risks.

"A simple instant-message-like feature that enables a dialogue between the user and the system is sufficient to evoke rich perceptions of interactivity, which, in turn, could favorably influence health behaviors and attitudes," Dr Bellur said. "Therein lies the power of interactive health tools."