Promoting Relational Agent for Health Behavior Change in Low and Middle - Income Countries (LMICs): Issues and Approaches
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The use of contemporary technologies in healthcare systems to improve quality of care and to promote behavioral healthcare outcomes are prevalent in high-income countries. However, low and middle-income countries (LMICs) are not receiving the same advantages of technology, which may be due to inadequate technological infrastructure and financial resources, lack of interest among policy makers and healthcare service providers, lack of skills and capacity among healthcare professionals in using technology based interventions, and resistance of the public to the use of technologies for healthcare or health promotion activities. Technology-based interventions offer considerable promise to develop entirely new models of healthcare both within and outside of formal systems of care and offer the opportunity to have a large public health impact. Such technology-based interventions could be used to address targeted global health problems in LMICs, including the chronic non-communicable diseases (NCDs) - a growing health system burden in LMICs. Major preventable behavioral risk factors of chronic NCDs are increasing in LMICs, and innovative interventions are essential to address these risk factors. Computer-based or mobile-based virtual coaches or Relational Agents (RAs) are increasingly being explored for counseling patients to change their health behavior in high-income countries; however, the use of RAs in LMICs has not been studied. In this paper, we summarize the growing application of RA technology in behavior change interventions in high-income countries and describe the potential of its use in LMICs. Finally, we review the potential barriers and challenges in promoting RAs in LMICs.
KeywordsRelational agent Mobile health (mHealth) Low and middle-income countries (LMICs) Information and communication technology (ICT)
Low and middle-income countries
Relational Agents (RAs)
Information and Communication Technology
World Health Organization
Embodied conversational agents
Personal digital assistants
International Monetary Fund
The authors would like to thank the staff of the Department of General Internal Medicine at Boston University Medical Center for administrative supports. Md Faisal Kabir worked as a summer intern (doctoral trainee) in the project.
Availability of data and materials
Available upon request from the corresponding author.
ASA planned the study and oversee the overall review process. FK led the review, identified relevant articles and summarized the findings. FK drafted the first draft of the manuscript and distributed to co-authors for comments. DS and ASA critically reviewed the draft manuscript and commented on the final draft. All authors approved the final draft of the paper.
This study was supported by the US National Institutes of Health (NIH) Fogarty International Centre [grant numbers R25TW009715; PI: Abu Abdullah]. The funders had no role in the design or conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review, and approval of the manuscript.
Compliance with Ethical Standards
Ethics Approval and Consent to Participate
This is a review article and no ethical approval was required.
Consent for Publication
All authors provided consent for this publication.
The authors declare that they have no competing interests.
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