Article summary of Artificial intelligence and immediacy: designing health communication to personally engage consumers and providers by Kreps & Neuhauser - Chapter

What is this article about?

In the field of health care, it is important to communicate. Communication is also important for the promotion of well-being. The efforts of health care aids have to capture the attention of people and have to personally engage health care participants in order to influence their behaviours and health decisions. However, this is not as easy as it sounds. Many health care efforts fail to achieve their goal and this is because they are not sufficiently engaging and involving. Research has shown that health communication efforts have failed because they used approaches that were too impersonal, boring and confusing. Some studies suggest that these efforts might even have unintended negative consequences when audience members do not respond to the messages as intended. This is usually the case when they find messages to be alienating, intimidating or insensitive. For example, there used to be a media campaign that tried to warn young people for the effects of drugs on the brain. It didn’t turn out like the creators of the campaign wanted to. The media campaign was perceived by at-risk youths as a trigger for them to experiment with these illegal drugs. It seems that this campaign failed to deliver relevant health information and obviously it didn’t reach its goals.

What is the role of Artifical Intelligence in e-health communication?

Nowadays, artificial intelligence is used in e-health communications and this offers great opportunities to increase the effectiveness of health promotion programs. This can be accomplished because health promotion programs enhance immediacy and it also makes e-health communication relevant, exciting and involving. The set of communication features that promote emotional and physical closeness is called immediacy. Immediacy promotes enthusiasm and authenticity. Artificial intelligence plays a central role in the design of e-health programs and it has been described as the engineering and science of intelligent machines. Artificial intelligence incorporates human intelligence capacities in computing. It enables the development of sophisticated e-health communication features. With the help of artificial intelligence, e-health applications can be made more human, interactive, emotionally expressive and adaptive. It also helps to enhance immediacy.

Health promotion needs health communication. Health communication program designers must recognize that health communication situations are often intense, emotional and highly charged, because of uncertainties about intervention strategies. These designers must design health communication programs to meet the need of consumers (patients, caregivers) and providers (nurses, pharmacists) and the health information must guide complex and time-sensitive health decisions to reduce health risks. But it is not that easy to accomplish effective health communication.

E-health programs are used to help to provide consumers with relevant health information and to gather information from consumers. The quality of communication of these technologies is crucial to provide sensitive, accurate and timely information. Sometimes, it may be difficult to motivate consumers to follow health recommendations and it may also be difficult to explain complex health behaviour to lay people.

Another thing that may cause a problem is that there might be difficulties in the cooperation between health team members. Patients are often scared by the health care system, feel challenged to participate in their own health care and find expressing health concerns difficult. It is important to equalize the communication dynamic between consumers and providers in the delivery of care and the promotion of health. This must be done to encourage active exchange of information and cooperation to accomplish complex health goals. E-health channels are advantageous channels to communicate with consumers. These programs are easily available wherever and whenever consumers need to interact with them. Consumers see these programs as more private and less judgmental. This encourages information sharing.

Problems with the quality of current health communication

Health caregivers typically focuses on health care procedures and technologies and they do not really focus on the communication of health information. This results in poor quality health communication and this inhibits achievement of desired health goals. Health communication efforts are usually boring and also unimaginative and intimidating. Providers and educators of health care are often emotionally unattached to consumers. Health care personnel has often limited time to treat many different patients and this makes them rush and appear to be superficial when communicating with patients. It seems that health promotion efforts often focus more on presenting scientific facts than connecting the information in engaging ways to consumers. There is also overuse of technical jargon that is difficult for the ‘normal’ people to understand. This can create psychological distance between professionals and the consumers. Jargon is overused in delivering information about health risks, intervention options and health recommendations. This overuse of scientific language is also found in written sources, like pamphlets, handouts and websites. The overuse of jargon leads to patient confusion. Some messages might even be disempowering; they might suggest that the consumers are to blame for their health problems. These messages might alienate consumers and make them feel bad about themselves. Recommendations are often very prescriptive and consumers do not have much input into their health care. Because of all of this, health communication is often not seen as a positive thing by the consumer.

How can we increase immediacy?

Communication factors are important for the effectiveness of health communication processes. These factors include accuracy, fidelity, timeliness, sensitivity and persuasiveness of messages exchanges. One of the most important dimensions of effective health communication is immediacy. This refers to how engaging the communication is. Immediacy is a dimension of human communication that influences physical and emotional closeness, comfort, personal involvement, intensity, enthusiasm and authenticity. Research on immediacy shows that higher levels of immediacy can promote relational closeness and cooperation with the subjects. Immediacy also enhances the expression of affect, increases affective learning, improves students’ perceptions of instructor credibility, encourages active communication, enhances motivation and reduces participant’s resistance. There has not been much attention paid to communicating immediacy in health care and health promotion research.

The few studies that have been conducted on communication immediacy suggests that immediacy can improve health care communication in many aspects.

What artificial intelligent strategies for increasing e-health immediacy?

Studies show that there are a couple of simple verbal and nonverbal communication strategies that can be used to enhance the immediacy of interactions in instructional contexts. These can also be used for e-health programs. To personalize communication, the health promotion intervention should use the name or nickname of the person. These programs should also include familiar terms and provide clear explanations of complex concepts. Tension must also be reduced. Interactive e-health programs should be designed to clarify and elaborate on information, answer questions of users and inform them on what different health decision options they have. E-health information systems should also be designed to seek feedback from consumers, encourage consumers to express their personal preferences and concerns. E-health systems also need to include empathy and concern for the users. This can be done by the use of avatars. These avatars smile to show friendliness and also use certain gestures to enhance active and dramatic nature of health communications. The avatars should also maintain eye contact with the user, to demonstrate personal involvement and use vocal variety when speaking to users. The change in posture can also help to increase immediacy. A relaxed body posture should be used to increase comfort and accessibility. The way the avatar is dressed could also help to increase immediacy. One study showed that colourful hats for patients, health care personnel and family members helped to enhance the health communication and increased engagement between health providers and health consumers.

What is the ChronologyMD project?

Crohn’s disease is an incurable and serious inflammatory bowel disease and costs the United States (the country the writers come from) 15 billion dollars a year! This disease is highly patient-specific and it can also be fatal. This is especially the case when it is not treated well. Crohn’s disease also presents health communication challenges, especially on the issue of immediacy. Patients need to carefully track weight and report symptoms, medication adherence and other data as accurately as possible to health care providers. This information is then used in treatment decisions.

However, it has been difficult for patients to collect complex, precise data. In 2010, the ChronologyMD project was started and this project wanted to provide computer-mediated (AI) support to patients to track their weight, sleep, activity, pain, medication adherence and symptoms on a daily or hourly basis and to share this information with health providers. A Chronology app was created, which allowed patients to put information about their disease into the app. This app sent personalized SMS, with reminders about putting data in the app, appointments, and medication. The patients also received a Withings electronic scale which automatically uploaded the patients’ weight, and the Chronograph app displayed the patient’s data in trend lines over a three-month period so that both the patients as well as the health providers could view the changes over time. The pilot study lasted two years.

Patients were asked for feedback on the system and this increased their immediacy. Some patients pushed for features that would allow them to write their own health narratives, like a journal, into the system. Patients reported positive outcomes to this system. They stated that the app helped them to them track, understand and monitor their condition. Doctors also appreciated this system, because it helped them to get detailed and timely information from their patients. They were also happy that patients wrote down their symptoms and that they felt like the patients were engaged more than before the use of the app.

This project shows that paying attention to the quality of the design can help enhance immediacy and this in turn increases consumer engagement and enhances health outcomes. In summary, the best e-health communication programs interact with users in ways that can promote immediacy by capturing the users’ attention, adapt to consumer interests, provide messages that are interesting, congruent, relevant and easy to understand, mirror users’ emotion appropriately, provide opportunities for social interaction and feedback, use verbal and nonverbal message systems, show empathy and care, and provide people with motivational information and suggestions.

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