Skip to main content

Hi, I’m Cecil(y) the Smoking Cessation Chatbot: The Effectiveness of Motivational Interviewing and Confrontational Counseling Chatbots and the Moderating Role of the Need for Autonomy and Self-efficacy

  • Conference paper
  • First Online:
Chatbot Research and Design (CONVERSATIONS 2022)

Part of the book series: Lecture Notes in Computer Science ((LNCS,volume 13815))

Included in the following conference series:

  • 1150 Accesses

Abstract

This study aimed to investigate if and how chatbots can increase smokers’ intention to quit, specifically looking into the effectiveness of two communication styles (i.e., motivational interviewing (MI) and confrontational counseling (CC)) and the moderating role of individual differences (i.e., need for autonomy and perceived self-efficacy) that may affect smokers’ experience with the chatbot. In an online between-subjects experiment (N = 233), smoking participants were assigned to interact with either a MI chatbot (n = 121) or a CC chatbot (n = 112) for one 8-min session. Their need for autonomy and perceived self-efficacy were measured, as well as their satisfaction with the conversation and pre- and post-test intention to quit smoking. No significant effects of different communication styles were found regarding the outcomes, nor did the need for autonomy moderate these results. However, the effect of MI on user satisfaction was more profound among smokers with higher self-efficacy, and a positive effect of self-efficacy on user satisfaction appeared. Additionally, interacting with the chatbots about one’s smoking behavior significantly increased participants’ intention to quit, regardless of its communication style. As such, this study sheds light on the potential of conversational chatbots for smoking cessation interventions, as well as pathways for future research.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zhu, S.-H., Lee, M., Zhuang, Y.-L., Gamst, A., Wolfson, T.: Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades? Tob. Control 21, 110–118 (2012)

    Article  Google Scholar 

  2. Thompson, L.E., Barnett, J.R., Pearce, J.R.: Scared straight? Fear-appeal anti-smoking campaigns, risk, self-efficacy and addiction. Health Risk Soc. 11, 181–196 (2009)

    Article  Google Scholar 

  3. Witte, K., Meyer, G., Martell, D.: Effective Health Risk Messages: A Step-By-Step Guide. Sage, New York (2001)

    Google Scholar 

  4. Organization, W.H.: WHO Report on the Global Tobacco Epidemic, 2021: Addressing new and emerging products. World Health Organization (2021)

    Google Scholar 

  5. Palanica, A., Flaschner, P., Thommandram, A., Li, M., Fossat, Y.: Physicians’ perceptions of chatbots in health care: cross-sectional web-based survey. J. Med. Internet Res. 21, e12887 (2019)

    Article  Google Scholar 

  6. Milne-Ives, M., et al.: The effectiveness of artificial intelligence conversational agents in health care: systematic review. J. Med. Internet Res. 22, e20346 (2020)

    Article  Google Scholar 

  7. Kotz, D., Huibers, M.J., West, R.J., Wesseling, G., van Schayck, O.C.: What mediates the effect of confrontational counselling on smoking cessation in smokers with COPD? Patient Educ. Couns. 76, 16–24 (2009)

    Article  Google Scholar 

  8. Miller, W.R., Rollnick, S.: Motivational Interviewing: Helping People Change. Guilford Press, New York (2012)

    Google Scholar 

  9. Heckman, C.J., Egleston, B.L., Hofmann, M.T.: Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis. Tob. Control 19, 410–416 (2010)

    Article  Google Scholar 

  10. Strecher, V.J., Shiffman, S., West, R.: Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapy. Addiction 100, 682–688 (2005)

    Article  Google Scholar 

  11. Deci, E.L., Ryan, R.M.: Self-determination theory: a macrotheory of human motivation, development, and health. Can. Psychol. 49, 182 (2008)

    Article  Google Scholar 

  12. Bandura, A.: Regulation of cognitive processes through perceived self-efficacy. Dev. Psychol. 25, 729 (1989)

    Article  Google Scholar 

  13. Schneider, R.J., Casey, J., Kohn, R.: Motivational versus confrontational interviewing: a comparison of substance abuse assessment practices at employee assistance programs. J. Behav. Health Serv. Res. 27, 60–74 (2000)

    Article  Google Scholar 

  14. Francis, N., Rollnick, S., McCambridge, J., Butler, C., Lane, C., Hood, K.: When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour. Addiction 100, 1175–1182 (2005)

    Article  Google Scholar 

  15. Moyers, T.B., Miller, W.R., Hendrickson, S.M.: How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. J. Consult. Clin. Psychol. 73, 590 (2005)

    Article  Google Scholar 

  16. Lundahl, B.W., Kunz, C., Brownell, C., Tollefson, D., Burke, B.L.: A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Res. Soc. Work. Pract. 20, 137–160 (2010)

    Article  Google Scholar 

  17. Ahluwalia, J.S., et al.: The effects of nicotine gum and counseling among African American light smokers: a 2 × 2 factorial design. Addiction 101, 883–891 (2006)

    Article  Google Scholar 

  18. Coleman, T., Cheater, F., Murphy, E.: Qualitative study investigating the process of giving anti-smoking advice in general practice. Patient Educ. Couns. 52, 159–163 (2004)

    Article  Google Scholar 

  19. Miller, W.R., Rollnick, S.: Meeting in the middle: motivational interviewing and self-determination theory. Int. J. Behav. Nutr. Phys. Act. 9, 1–2 (2012)

    Article  Google Scholar 

  20. Liu, B., Sundar, S.S.: Should machines express sympathy and empathy? Experiments with a health advice chatbot. Cyberpsychol. Behav. Soc. Netw. 21, 625–636 (2018)

    Article  Google Scholar 

  21. He, L., Basar, E., Wiers, R.W., Antheunis, M.L., Krahmer, E.: Can chatbots help to motivate smoking cessation? A study on the effectiveness of motivational interviewing on engagement and therapeutic alliance. BMC Public Health 22, 1–14 (2022)

    Article  Google Scholar 

  22. Shingleton, R.M., Palfai, T.P.: Technology-delivered adaptations of motivational interviewing for health-related behaviors: a systematic review of the current research. Patient Educ. Couns. 99, 17–35 (2016)

    Article  Google Scholar 

  23. De Vreede, T., Raghavan, M., De Vreede, G.-J.: Design Foundations for AI Assisted Decision Making: A Self Determination Theory Approach (2021)

    Google Scholar 

  24. Smit, E.S., Bol, N.: From self-reliers to expert-dependents: identifying classes based on health-related need for autonomy and need for external control among mobile users. Media Psychol. 23, 391–414 (2020)

    Article  Google Scholar 

  25. Altendorf, M.B., van Weert, J.C., Hoving, C., Smit, E.S.: Should or could? Testing the use of autonomy-supportive language and the provision of choice in online computer-tailored alcohol reduction communication. Digital health 5, 2055207619832767 (2019)

    Article  Google Scholar 

  26. Hyde, J., Hankins, M., Deale, A., Marteau, T.M.: Interventions to increase self-efficacy in the context of addiction behaviours: a systematic literature review. J. Health Psychol. 13, 607–623 (2008)

    Article  Google Scholar 

  27. Gaume, J., Gmel, G., Faouzi, M., Daeppen, J.-B.: Counselor skill influences outcomes of brief motivational interventions. J. Subst. Abuse Treat. 37, 151–159 (2009)

    Article  Google Scholar 

  28. Colby, S.M., et al.: Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: results from a randomized clinical trial. Addict. Behav. 37, 817–823 (2012)

    Article  Google Scholar 

  29. Madson, M.B., et al.: Measuring client perceptions of motivational interviewing: factor analysis of the client evaluation of motivational interviewing scale. J. Subst. Abuse Treat. 44, 330–335 (2013)

    Article  Google Scholar 

  30. Heatherton, T.F., Kozlowski, L.T., Frecker, R.C., Fagerstrom, K.O.: The Fagerström test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br. J. Addict. 86, 1119–1127 (1991)

    Article  Google Scholar 

  31. Komissarouk, S., Harpaz, G., Nadler, A.: Dispositional differences in seeking autonomy-or dependency-oriented help: conceptual development and scale validation. Personality Individ. Differ. 108, 103–112 (2017)

    Article  Google Scholar 

  32. Spek, V., Lemmens, F., Chatrou, M., van Kempen, S., Pouwer, F., Pop, V.: Development of a smoking abstinence self-efficacy questionnaire. Int. J. Behav. Med. 20, 444–449 (2013)

    Article  Google Scholar 

  33. Biener, L., Abrams, D.B.: The contemplation ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol. 10, 360 (1991)

    Article  Google Scholar 

  34. Larsen, D.L., Attkisson, C.C., Hargreaves, W.A., Nguyen, T.D.: Assessment of client/patient satisfaction: development of a general scale. Eval. Program Plann. 2, 197–207 (1979)

    Article  Google Scholar 

  35. Shiffman, S., Brockwell, S.E., Pillitteri, J.L., Gitchell, J.G.: Individual differences in adoption of treatment for smoking cessation: demographic and smoking history characteristics. Drug Alcohol Depend. 93, 121–131 (2008)

    Article  Google Scholar 

  36. Van den Broeck, E., Zarouali, B., Poels, K.: Chatbot advertising effectiveness: when does the message get through? Comput. Hum. Behav. 98, 150–157 (2019)

    Article  Google Scholar 

  37. Secades-Villa, R., Alonso-Pérez, F., García-Rodríguez, O., Fernández-Hermida, J.R.: Effectiveness of three intensities of smoking cessation treatment in primary care. Psychol. Rep. 105, 747–758 (2009)

    Article  Google Scholar 

  38. Kontos, E., Blake, K.D., Chou, W.-Y.S., Prestin, A.: Predictors of eHealth usage: insights on the digital divide from the health information national trends survey 2012. J. Med. Internet Res. 16, e3117 (2014)

    Article  Google Scholar 

  39. Safi, Z., Abd-Alrazaq, A., Khalifa, M., Househ, M.: Technical aspects of developing chatbots for medical applications: scoping review. J. Med. Internet Res. 22, e19127 (2020)

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Linwei He .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Leeuwis, L., He, L. (2023). Hi, I’m Cecil(y) the Smoking Cessation Chatbot: The Effectiveness of Motivational Interviewing and Confrontational Counseling Chatbots and the Moderating Role of the Need for Autonomy and Self-efficacy. In: Følstad, A., et al. Chatbot Research and Design. CONVERSATIONS 2022. Lecture Notes in Computer Science, vol 13815. Springer, Cham. https://doi.org/10.1007/978-3-031-25581-6_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-25581-6_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-25580-9

  • Online ISBN: 978-3-031-25581-6

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics