Artificial intelligence and immediacy: Designing health communication to personally engage consumers and providers
Introduction
Communication is central to the delivery of health care and promotion of well-being. Yet, to be effective, health communication efforts have to actively capture the attention and personally engage health care participants to influence health decisions and behaviors. This is not easy to accomplish, and frankly many health communication efforts fail to accomplish their goals because they are not designed to be sufficiently involving and engaging. Decades of research show that many health communication efforts have failed because the approaches used have been overly generic, impersonal, confusing, and boring [1], [2], [3], [4], [5]. Health communication efforts may even have unintended negative (“boomerang”) consequences when audience members do not respond to messages as intended, often because they find the messages to be alienating, insensitive or intimidating [6]. For example, the National Youth Anti-drug Media Campaign was designed to discourage drug abuse by emphasizing harmful effects of illegal drugs on the brain, but was perceived by at-risk youth as daring them to experiment with using illegal drugs [7]. Problematic health communication programs, like this one, fail to effectively deliver relevant health information as intended to guide informed health decisions, and do not achieve intended goals for promoting the adoption of healthy behaviors.
Fortunately, the use of artificial intelligence (AI) in e-health communication offers exceptional opportunities to increase the effectiveness of health promotion programs by enhancing immediacy and making ehealth communication engaging, relevant, involving, exciting, and actionable. Immediacy is a set of communication features that promote physical and emotional closeness, engaging and caring relationships, as well as authenticity and enthusiasm [2]. AI, which has become central to designing many ehealth programs, has been described as the science and engineering of intelligent machines [8]. AI helps to incorporate human intelligence capacities in computing, enabling the development of sophisticated ehealth communication features, including intuitive human–computer interfaces, congruent interaction responses, customized reminders to meet specific user needs, responsive monitors that record and adapt to users’ experiences and physical/psychological states (such as movement, respiration, heartbeat, and brain waves), and engaging relational agents that can interact meaningfully with consumers as advisers, educators, and even therapists. In essence, AI can be used to make ehealth applications more human, adaptive, interactive, emotionally expressive, and can dramatically enhance immediacy.
Health communication is central to health promotion and is pervasive in most, if not all, health situations and contexts (such as hospital emergency rooms, surgical suites, medical offices, workplaces, schools, and homes) [9], [10]. Designers of health communication programs must leverage the unique uses of various channels of communication with particular regard for access, preference, and utilization by key audiences in different health contexts. They must recognize that health communication situations are often fast-paced, highly charged, intense, and emotional due to many uncertainties about health risks and intervention strategies. They must design health communication program to meet the urgent needs of consumers (e.g., patients, caregivers, survivors, support group members) and providers (e.g., physicians, nurses, therapists, pharmacists, nutritionists, social workers, health educators) for relevant health information to guide complex, time-sensitive, and challenging health decisions for reducing health risks, selecting treatment options, and adopting sometimes difficult healthy lifestyle choices However, effective health communication is not easy to accomplish. The quality of health communication programs is crucial to achieving desired health outcomes [11], [12], [13].
Health information technologies (ehealth programs) are being increasingly used to support the communication demands of health care delivery and health promotion, helping both to provide consumers with relevant health information and gather information from consumers. Yet, the quality of communication with these technologies is crucial for providing consumers and providers with the accurate, timely, sensitive, and adaptive health information they need. If there is a breakdown in the ways health risks, treatment regimens, and recommended health behaviors are communicated, there will be problems with encouraging consumers to accept and incorporate health recommendations (such as following therapeutic procedures, taking prescribed medications, and adopting health promotion strategies) [14]. It is not easy to explain complex health information to lay audiences, and even more difficult to motivate consumers to faithfully follow health recommendations. It is also a challenge to elicit interprofessional cooperation between health team members to deliver coordinated care. There are many instances in the delivery of care when communication is not ideal, providers and consumers do not have access to or understanding of the best information for guiding health decisions, leading to breakdowns in the health care/promotion process [15], [16], [17]. Smart, adaptive, interactive, and immediate ehealth programs can help supplement and enhance health information sharing to achieve health goals [4].
Patients are often intimidated by the health care system, have difficulties expressing their health concerns, and feel challenged to participate fully in directing their own health care [15], [16], [17], [18], [19]. It is critically important to equalize the communication dynamics between consumers and providers in the delivery of care and promotion of health to encourage active exchange of information and cooperation to accomplish complex health goals. Ehealth programs are often advantageous channels to communicate with consumers, since they are often easily available wherever and whenever consumers may need to interact, are perceived by consumers as being more private and less judgmental than interacting directly with health care providers, can reduce relational power discrepancies encouraging information sharing and participation, and have infinite patience for listening, recording, and repeating/explaining information when necessary [3], [20]. Care must be taken in health promotion efforts to craft messages that are appropriate and compelling to target audiences, deliver these messages through the most effective communication channels, and reinforce adoption of healthy behaviors over time. We will describe the design and evaluation of two mobile ehealth applications – the ChronologyMD system – that enhances the immediacy of health communication by using AI to provide consumers confronting Crohn's disease with personal, engaging, and dynamic narrative-based health information to help them monitor their conditions and direct their care.
Section snippets
Problems with the quality of current health communication practices
Close attention needs to be paid to the quality of communication in the delivery of care and promotion of health. Health care and promotion efforts typically focus on health care procedures and technologies, and not on the communication of health information. This often results in poor quality health communication that inhibits, rather than facilitates, achievement of desired health outcomes. Several qualitative factors in the delivery of health care and promotion of health need greater
Increasing immediacy to promote engaging health communication
The effectiveness of health communication processes depends upon multiple communication factors, including the accuracy, timeliness, fidelity, persuasiveness, and sensitivity of messages exchanged. One of the most important, and largely unrecognized, dimensions of effective health communication relates to how engaging the communication is, a process often referred to in the communication literature as “immediacy” [2], [3]. Immediacy is a critical factor in determining whether communication
AI strategies for enhancing ehealth immediacy and engagement
Research has shown that there are a variety of relatively simple verbal and nonverbal communication strategies that can be used to enhance the immediacy of interactions in instructional contexts that can be applied very well to the design of ehealth promotion programs [3], [21], [22], [23], [24], [25], [26]. There are several straightforward verbal strategies that can be used for promoting immediacy in ehealth promotion programs. For example, it is a good idea when developing health promotion
The ChronologyMD project, AI and immediacy
Crohn's is a serious, incurable, inflammatory bowel disease that affects about 600,000 people in the US and costs an estimated $15 billion per year [37], [38]. It is highly patient-specific, and can be fatal, especially if not carefully managed. Crohn's presents significant health communication challenges that relate to issues of immediacy. Patients need to carefully track weight, medication adherence, and many symptoms, and report those data and their trends to providers accurately. Providers
Discussion
Immediacy is a critically important feature of effective ehealth communication programs. Ehealth programs that attract user attention and involvement can enhance health education and influence relevant health behaviors. AI applications are well-suited to enhancing the immediacy of ehealth programs by humanizing health communication and making these programs engaging, relevant, exciting, and actionable. The ChronolgyMD ehealth program exemplifies the effective use of AI to promote consumer
Funding information
Support for the ChronologyMD research reported in this publication was provided by Project HealthDesign, a national program of the Robert Wood Johnson Foundation's Pioneer Portfolio.
Conflict of interest
None of the authors of the manuscript has a conflict of interest that would inappropriately influence, or be perceived to inappropriately influence their work.
Acknowledgements
We appreciate the support of Kathleen Morrison and other ChronologyMD team members in providing patient and provider information from the ChronologyMD project described in this manuscript.
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