The co-design of an embodied conversational agent to help stroke survivors manage their recovery

Whilst the use of digital interventions to assist patients with self-management involving embodied conversational agents (ECA) is emerging, the use of such agents to support stroke rehabilitation and recovery is rare. This iTakeCharge project takes inspiration from the evidence-based narrative style self-management intervention for stroke recovery, the ‘Take Charge’ intervention, which has been shown to contribute to significant improvements in disability and quality of life after stroke. We worked with the developers and deliverers of the ‘Take Charge’ intervention tool, clinical stroke researchers and stroke survivors, to adapt the ‘Take Charge’ intervention tool to be delivered by an ECA (i.e., the Taking Charge Intelligent Agent (TaCIA)). TaCIA was co-designed using a three-phased approach: Stage 1: Phase I with the developers and Phase II with people who delivered the original Take Charge intervention to stroke survivors (i.e., facilitators); and Stage 2: Phase III with stroke survivors. This paper reports the results from each of these phases including an evaluation of the resulting ECA. Stage 1: Phase I, where TaCIA V.1 was evaluated by the Take Charge developers, did not build a good working alliance, provide adequate options, or deliver the intended Take Charge outcomes. In particular, the use of answer options and the coaching aspects of TaCIA V.1 were felt to conflict with the intention that Take Charge facilitators would not influence the responses of the patient. In response, in Stage 1: Phase II, TaCIA V.2 incorporated an experiment to determine the value of providing answer options versus free text responses. Take Charge facilitators agreed that allowing an open response concurrently with providing answer options was optimal and determined that working alliance and usability were satisfactory. Finally, in Stage 2: Phase III, TaCIA V.3 was evaluated with eight stroke survivors and was generally well accepted and considered useful. Increased user control, clarification of TaCIA’s role, and other improvements to improve accessibility were suggested. The article concludes with limitations and recommendations for future changes based on stroke survivor feedback.