Skip to main content

Virtual Assistant to Improve Self-care of Older People with Type 2 Diabetes: First Prototype

  • Conference paper
  • First Online:
Gerontechnology (IWoG 2018)

Abstract

Diabetes has significant clinical, economic and humanistic implications, both at a national and global level. Type 2 diabetes (T2D) is highly prevalent in older people. This paper describes a first prototype of an application intended to facilitate self-care of older people with T2D, supplementing appointments with healthcare professionals. The application is based on a virtual assistant with an anthropomorphic representation. The virtual assistant is capable of speaking and expressing emotions through facial and body animations; it has been designed to act as a relational agent, developing long-term relationships with users. It targets adherence to medication, physical activity and diet, tailoring the intervention to users’ needs and characteristics. The Behavior Change Wheel was chosen as the theoretical approach to behaviour change and supports dialogue content. Built for Android devices, the architecture of the application first prototype includes a core component, a dialogue creator, a speech generator and a database. The first tests on the application contents and usability were conducted in a sample of ten academic nurses with expertise in primary care. Overall, these tests yielded a positive opinion, as well as suggestions for improvement. On-going work includes testing the first prototype with older people with T2D plus health professionals in primary care units of the Portuguese National Health Service, and incorporating a rule-based context-sensitive dialogue manager, which is expected to convey a more flexible dialogue flow.

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 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
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

Notes

  1. 1.

    http://www.nightinthewoods.com/.

  2. 2.

    http://foamswordgames.com/.

  3. 3.

    https://harposoftware.com/en/2-main/s-1/index/brand-speech2goivona/language-portuguese.

  4. 4.

    https://www.sqlite.org/index.html.

  5. 5.

    https://www.daz3d.com/.

References

  1. World Health Organization. Global report on diabetes (2016)

    Google Scholar 

  2. Zheng, Y., Ley, S.H., Hu, F.B.: Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat. Rev. Endocrinol. 14(2), 88 (2018)

    Article  Google Scholar 

  3. Observatório, Da Diabetes. Diabetes Factos e Números o ano de 2015-Relatório Anual do Observatório Nacional da Diabetes. Sociedade Portuguesa de Diabetologia (2016)

    Google Scholar 

  4. García-Pérez, L.E., Alvarez, M., Dilla, T., Gil-Guillén, V., Orozco-Beltrán, D.: Adherence to therapies in patients with type 2 diabetes. Diab. Ther. 4(2), 175–194 (2013)

    Article  Google Scholar 

  5. Lavie, C.J., et al.: Exercise is medicine—The importance of physical activity, exercise training, cardiorespiratory fitness, and obesity in the prevention and treatment of type 2 diabetes. Eur. Endocrinol. 10(1), 18 (2010)

    Article  Google Scholar 

  6. Norris, S.L., Engelgau, M.M., Narayan, K.M.: Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diab. Care 24(3), 561–587 (2001)

    Article  Google Scholar 

  7. Pal, K., et al.: Computer-based interventions to improve self-management in adults with type 2 diabetes: A systematic review and meta-analysis. Diab. Care 37(6), 1759–1766 (2014)

    Article  Google Scholar 

  8. Alharbi, N.S., et al.: Impact of information technology–based interventions for type 2 diabetes mellitus on glycemic control: A systematic review and meta-analysis. J. Med. Internet Res. 18, 11 (2016)

    Article  Google Scholar 

  9. Bickmore, T., Schulman, D., Yin, L.: Maintaining engagement in long-term interventions with relational agents. Appl. Artif. Intell. 24(6), 648–666 (2010)

    Article  Google Scholar 

  10. Bickmore, T.W., Mitchell, S.E., Jack, B.W., Paasche-Orlow, M.K., Pfeifer, L.M., O’Donnell, J.: Response to a relational agent by hospital patients with depressive symptoms. Interact. Comput. 22(4), 289–298 (2010)

    Article  Google Scholar 

  11. Bickmore, T.W., Gruber, A.: Relational agents in clinical psychiatry. Harvard Rev. Psychiatry 18(2), 119–130 (2010)

    Article  Google Scholar 

  12. Ring, L., Bickmore, T.W., Pedrelli, P.: An affectively aware virtual therapist for depression counseling. In: ACM SIGCHI Conference on Human Factors in Computing Systems (CHI) Workshop on Computing and Mental Health (2016)

    Google Scholar 

  13. Provoost, S., Lau, H.M., Ruwaard, J., Riper, H.: Embodied conversational agents in clinical psychology: A scoping review. J. Med. Internet Res. 19(5), e151 (2017)

    Article  Google Scholar 

  14. Zhang, Z., et al.: Maintaining continuity in longitudinal, multi-method health interventions using virtual agents: The case of breastfeeding promotion. In: Bickmore, T., Marsella, S., Sidner, C. (eds.) IVA 2014. LNCS (LNAI), vol. 8637, pp. 504–513. Springer, Cham (2014). https://doi.org/10.1007/978-3-319-09767-1_61

    Chapter  Google Scholar 

  15. Bickmore, T.W., Caruso, L., Clough-Gorr, K.: Acceptance and usability of a relational agent interface by urban older adults, p. 1212 (2005)

    Google Scholar 

  16. Bickmore, T.W., Caruso, L., Clough-Gorr, K., Heeren, T.: ‘It’s just like you talk to a friend’ relational agents for older adults. Interact. Comput. 17(6), pp. 711–735, Dez (2005)

    Article  Google Scholar 

  17. Watson, A., Bickmore, T.W., Cange, A., Kulshreshtha, A., Kvedar, J.: An internet-based virtual coach to promote physical activity adherence in overweight adults: Randomized controlled trial. J. Med. Internet Res. 14(1), e1 (2012)

    Article  Google Scholar 

  18. Bickmore, T.W., et al.: A randomized controlled trial of an automated exercise coach for older adults. J. Am. Geriatr. Soc. 61(10), 1676–1683 (2013)

    Article  Google Scholar 

  19. King, A.C., et al.: Testing the comparative effects of physical activity advice by humans vs. computers in underserved populations: The COMPASS trial design, methods, and baseline characteristics. Contemp. Clin. Trials 61, 115–125 (2017)

    Article  Google Scholar 

  20. Sillice, M.A., et al.: Using relational agents to promote exercise and sun protection: Assessment of participants’ experiences with two interventions. J. Med. Internet Res. 20(2), e48 (2018)

    Article  Google Scholar 

  21. ACSM: ACSM’s Guidelines for Exercise Testing and Prescription, 10th Revised edn. Wolters Kluwer, Philadelphia (2017)

    Google Scholar 

  22. Bickmore, T.W., Puskar, K., Schlenk, E.A., Pfeifer, L.M., Sereika, S.M.: Maintaining reality: Relational agents for antipsychotic medication adherence. Interact. Comput. 22(4), 276–288 (2010)

    Article  Google Scholar 

  23. Monkaresi, H., et al.: Intelligent diabetes lifestyle coach. In: Fifth International Workshop on Smart Healthcare and Wellness Applications (SmartHealth 2013), Adelaide, Australia (2013)

    Google Scholar 

  24. Thompson, D., Cullen, K.W., Redondo, M.J., Anderson, B.: Use of relational agents to improve family communication in type 1 diabetes: Methods. JMIR Res. Protoc. 5(3), e151 (2016)

    Article  Google Scholar 

  25. INE: Sociedade da Informação e do Conhecimento – “Inquérito à Utilização de Tecnologias da Informação e da Comunicação pelas Famílias”, Lisboa (2015)

    Google Scholar 

  26. Migneault, J.P., Farzanfar, R., Wright, J.A., Friedman, R.H.: How to write health dialog for a talking computer. J. Biomed. Inform. 39, 468–481 (2006)

    Article  Google Scholar 

  27. Bickmore, T.W., Schulman, D., Sidner, C.: A reusable framework for health counseling dialogue systems based on a behavioral medicine. J. Biomed. Inform. 44, 183–197 (2011)

    Article  Google Scholar 

  28. Michie, S., Atkins, L., West, R.: The Behaviour Change Wheel – A Guide to Designing Intervention. Silverback Publishing, London (2014)

    Google Scholar 

  29. Michie, S., et al.: The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Ann. Behav. Med. 46, 81–95 (2013)

    Article  Google Scholar 

  30. Cláudio, A.P., et al.: Virtual humans for training and assessment of self-medication consultation skills in pharmacy students. In: 2015 10th International Conference on Computer Science & Education (ICCSE). IEEE (2015)

    Google Scholar 

  31. Pastore, E., Rosa, L.D., Homem, I.D.: Relações de gênero e poder entre trabalhadores da área da saúde. In: Fazendo Gênero 8 - Corpo, Violência e Poder (2008)

    Google Scholar 

  32. Cabral, J.P., Cowan, B.R., Zibrek, K., McDonnell, R.: The influence of synthetic voice on the evaluation of a virtual character. In: Proc. Interspeech, pp. 229–233 (2017). https://doi.org/10.21437/interspeech.2017-325

  33. Malanda, U.L., Welschen, L.M.C., Riphagen, I.I., Dekker, J.M., Nijpels, G., Bot, S.D.M.: Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst. Rev. 1(1) (2012). https://doi.org/10.1002/14651858.CD005060.pub3, Article No. CD005060

  34. Farmer, A.J., et al.: Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ 344, e486 (2012)

    Article  Google Scholar 

  35. Report on Self-Monitoring of Blood Glucose (SMBG) in Type 2 Diabetes Mellitus. Medicines Management Programme (2016). http://www.hse.ie/eng/services/publications/Clinical-Strategy-and-Programmes/Report-on-Self-Monitoring-of-Blood-Glucose-SMBG-in-Type-2-Diabetes-Mellitus.pdf

  36. Risso, T., Furtado, C.: Rational use of blood glucose test strips for self-monitoring in patients with diabetes mellitus: Economic impact in the Portuguese healthcare system. Diabetes Res. Clin. Pract. 134, 161–167 (2017)

    Article  Google Scholar 

Download references

Acknowledgements

The authors are indebted to Adriana Henriques and Isabel Costa e Silva for their work in the VASelfCare project, as team members.

The authors express their gratitude to the advisory board members and the academic nurses who participated in the tests.

This work was supported by FCT and Compete 2020 (grant number LISBOA-01-0145-FEDER-024250).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mara Pereira Guerreiro .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Buinhas, S. et al. (2019). Virtual Assistant to Improve Self-care of Older People with Type 2 Diabetes: First Prototype. In: García-Alonso, J., Fonseca, C. (eds) Gerontechnology. IWoG 2018. Communications in Computer and Information Science, vol 1016. Springer, Cham. https://doi.org/10.1007/978-3-030-16028-9_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16028-9_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16027-2

  • Online ISBN: 978-3-030-16028-9

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics