An embodied conversational agent to support wellbeing after injury: insights from a stakeholder inclusive design approach

Embodied conversational agents (ECAs) are increasingly being included in digital health and wellbeing programs. Whilst initial evaluations of ECAs in this field have been promising, there has been a lack of detail as to how stakeholders and end users have been included in the design process. Stakeholder inclusion has been acknowledged as essential to ensure that ECAs meet expectations, maximize engagement and facilitate behavior change. This study describes an iterative coproduction process used to develop an emotion regulation intervention conversational agent (ERICA) to support people following injury. The coproduction process followed an accelerated creation approach with 13 qualitative interviews being conducted with people who had a lived experience of recovering from injury/adversity. Interviews were completed with the goal to understand barriers and facilitators to engagement, user experience and to identify opportunities for program improvement. Four broad themes emerged from the data: visual look, voice, content and experience. A key finding from this study was a high level of stakeholder apprehension of generative AI and the need for ECA designers to make explicit the specific technology and functions being used within programs. Findings highlight the value of timely stakeholder inclusion in digital intervention design, particularly when knowledge and expectations of generative technology is rapidly changing.