Virtual patient advocate shows promise in reducing risky pregnancies

By: Neil Versel | May 2, 2013        

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Gabby AvatarYoung, low-income, minority women respond favorably to a “virtual patient advocate” that talks to them in plain English in a conversational, non-confrontational manner about birth control and other “preconception planning” issues, preliminary testing of the technology shows. Some even prefer the avatar to an actual physician, according to an article in the American Journal of Health Promotion.

The study, conducted at Boston Medical Center using technology developed at nearby Northeastern University, asked 24 African-American women between the ages of 15 and 25 to interact with a virtual character named Gabby to screen them for risks of unintended and dangerous pregnancies. Questions address issues as diverse as family planning, whether people have diabetes or other medical conditions that could affect the risk of birth defects, exposure to teratogens – substances that can cause developmental disorders – and preventive measures sexually active women can take.

Minority and low-income communities tend to have higher incidences of unplanned pregnancies and of maternal and infant mortality, the researchers say, citing earlier studies.

The Gabby system, created by Timothy Bickmore, a computer science professor at Northeastern, speaks in simple, conversational language. Users respond by clicking buttons on the screen specific to each question, and Gabby provides further dialog based on each response. “She’ll talk to you as long as you want,” lead author Dr. Paula Gardiner, a family physician at Boston Medical Center and a faculty member at Boston University School of Medicine, explains.

Gabby also educates users about unhealthy behavior and helps women create to-do lists for mitigating risks through lifestyle changes. “She’s helping you set goals,” Gardiner says.

“She lets you set the goals and she reinforces the goal settings,” Gardiner continues. “In that sense, she’s like a coach.”

Bickmore, who has focused his career on relational agents, tools that enable people to develop social and emotional attachments with computerized figures, employs motivational interviewing, a psychological technique that helps people understand unhealthy behaviors and take steps to change their habits, according to Gardiner.

The 24 participants in the two-month pilot covered in the American Journal of Health Promotion reported an average of 23 preconception risks each, according to the study. At the end of the two months, the women addressed and/or resolved 83 percent of risks added to their personal to-do lists. “Therefore, Gabby was effective in helping those who were contemplating behavior change to move forward and take action,” says the paper.

Some of those who participated said they liked the fact Gabby had the persona of a young African-American woman they could relate to, according to the journal article, even though the voice sounds more computer-generated than human. “All of her dialog is written in a culturally sensitive way,” Gardiner says.

Gardiner reports being surprised at the positive response to the system, including the finding that some people actually would rather talk to the virtual advocate than to a real person. “Is it the simple words? The anonymity? Or is it this generation has grown up with technology?” Gardiner wonders aloud. “Maybe it’s all of it.”

Gabby is a way of relating to a generation that grew up on technology, including some people who never knew a world without the Internet, according to Gardiner. “It’s a way of meeting them where they are now,” she says. The system helps build community, as users can e-mail friends to invite them to join.

Further research will attempt to uncover the reasons. Grants from the U.S. Agency for Healthcare Research and Quality (AHRQ), the Health Resources and Services Administration (HRSA) and the National Institutes of Health (NIH) funded the initial study, and the NIH grant will allow the Boston team to extend the research for five years, Gardiner says. She already is recruiting 100 subjects to determine whether preconception care from Gabby can lower risk factors over a six-month period.

Additional work will include more qualitative research, including focus groups and one-on-one interviews, to find out why people like the virtual patient advocate, she adds.

For more, watch this brief video demonstration of the Gabby system.

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