Personalized and tailored health education materials have demonstrated greater effectiveness than generic content.Traditional tailoring methods in health communication typically rely on collecting user data through static forms and applying rule-based techniques to assemble health documents for print or digital delivery.In this project, we developed a novel system that combined a virtual agent (VA) with a large language model (LLM) to generate individualized breast cancer screening pamphlets.The VA conducted interactive interviews to gather user-specific information, including demographics, family history, and lifestyle factors.This information was then used by the LLM to generate a pamphlet that was both tailored and personalized.We conducted a pilot study to evaluate this approach, using breast cancer screening as a representative educational topic.Participants interacted with the virtual agent and provided relevant personal information before being randomized to receive either an LLM-generated pamphlet or a standard, generic pamphlet.We assessed group differences in knowledge, screening intentions, and satisfaction.Results showed that both groups experienced significant knowledge gains, with the Tailored group demonstrating greater improvement.Qualitative feedback revealed that participants who received the personalized and tailored pamphlets perceived the information as more personally relevant, often noting that the content reflected details they had shared during their interaction with the agent.These findings highlight the potential of integrating the VA and LLMs to enhance the personalization and effectiveness of health education materials.

Many laypeople are motivated to improve the health behavior of their family or friends but do not know where to start, especially if the health behavior is potentially stigmatizing or controversial. We present an approach that uses virtual agents to coach community-based volunteers in health counseling techniques, such as motivational interviewing, and allows them to practice these skills in role-playing scenarios. We use this approach in a virtual agent-based system to increase COVID-19 vaccination by empowering users to influence their social network. In a between-subjects comparative design study, we test the effects of agent system interactivity and role-playing functionality on counseling outcomes, with participants evaluated by standardized patients and objective judges. We find that all versions are effective at producing peer counselors who score adequately on a standardized measure of counseling competence, and that participants were significantly more satisfied with interactive virtual agents compared to passive viewing of the training material. We discuss design implications for interpersonal skills training systems based on our findings.

Smartphone-based conversational agents offer a convenient way to deliver health education, particularly for managing complex health conditions such as chronic diseases. The present study explores using a smartphone-based virtual agent system to aid patients with a chronic heart condition—atrial fibrillation—to manage their health by encouraging the use of a heart rhythm sensor integrated with their smartphones. We report the results of a randomized clinical trial with 240 patients experiencing atrial fibrillation who were provided with smartphones and heart rhythm sensors for 4 months. Participants in the intervention group interacted with a virtual agent, while the control group received general health education via the WebMD app. Intervention participants completed a median 91 interactions with the agent over the 4 months of the study period, and agent features designed to increase engagement–such as storytelling–were effective at increasing use. The agent’s promotion of heart rhythm sensor use was effective, with intervention participants taking significantly more heart rhythm readings compared to those in the control group. Participants were followed for 8 months thereafter to assess the sustainability of the effects, specifically focusing on medication adherence.

Virtual health counselors offer the potential to provide users with information and counseling in complex areas such as disease management and health education. However, ensuring user engagement is challenging, particularly when the volume of information and length of counseling sessions increase. Agenda setting—–a clinical counseling technique where a patient and clinician collaboratively decide on session topics—–is an effective approach to tailoring discussions for individual patient needs and sustaining engagement. We explore the effectiveness of agenda setting in a virtual counselor system designed to counsel women for breast cancer genetic testing. In a between-subjects study, we assessed three versions of the system with varying levels of user control in the system’s agenda setting approach. We found that participants’ knowledge improved across all conditions. Although our results showed that any type of agenda setting was perceived as useful, regardless of user control, interviews revealed a preference for more collaboration and user involvement in the agenda setting process. Our study highlights the importance of using patient-centered approaches, such as tailored discussions, when using virtual counselors in healthcare.