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Promoting Relational Agent for Health Behavior Change in Low and Middle - Income Countries (LMICs): Issues and Approaches

  • Mobile & Wireless Health
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Abstract

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.

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Abbreviations

LMICs:

Low and middle-income countries

RAs:

Relational Agents (RAs)

ICT:

Information and Communication Technology

WHO:

World Health Organization

mHealth:

Mobile health

ECA:

Embodied conversational agents

PDA:

Personal digital assistants

IMF:

International Monetary Fund

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Acknowledgements

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.

Funding

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.

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Authors and Affiliations

  1. Department of Computer Science, North Dakota State University, Fargo, ND, 58108, USA

    Md Faisal Kabir

  2. Philips Research North America, 2 Canal Park, 3rd Floor, Cambridge, MA, 02141, USA

    Daniel Schulman

  3. Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA, 02118, USA

    Abu S. Abdullah

  4. Duke Global Health Institute, Duke University, Durham, NC, 27710, USA

    Abu S. Abdullah

  5. Global Health Program, Duke Kunshan University, Kunshan, 215347, Jiangsu Province, China

    Abu S. Abdullah

Authors
  1. Md Faisal Kabir
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  2. Daniel Schulman
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  3. Abu S. Abdullah
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Contributions

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.

Corresponding author

Correspondence to Abu S. Abdullah.

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Kabir, M.F., Schulman, D. & Abdullah, A.S. Promoting Relational Agent for Health Behavior Change in Low and Middle - Income Countries (LMICs): Issues and Approaches. J Med Syst 43, 227 (2019). https://doi.org/10.1007/s10916-019-1360-z

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