Background: Cardiometabolic diseases (CMDs) are a group of interrelated conditions, including heart failure and diabetes, that increase the risk of cardiovascular and metabolic complications. The rising number of Australians with CMDs has necessitated new strategies for those managing these conditions, such as digital health interventions. The effectiveness of digital health interventions in supporting people with CMDs is dependent on the extent to which users engage with the tools. Augmenting digital health interventions with conversational agents, technologies that interact with people using natural language, may enhance engagement because of their human-like attributes. To date, no systematic review has compiled evidence on how design features influence the engagement of conversational agent–enabled interventions supporting people with CMDs. This review seeks to address this gap, thereby guiding developers in creating more engaging and effective tools for CMD management. Objective: The aim of this systematic review is to synthesize evidence pertaining to conversational agent–enabled intervention design features and their impacts on the engagement of people managing CMD. Methods: The review is conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be conducted in the Ovid (Medline), Web of Science, and Scopus databases, which will be run again prior to manuscript submission. Inclusion criteria will consist of primary research studies reporting on conversational agent–enabled interventions, including measures of engagement, in adults with CMD. Data extraction will seek to capture the perspectives of people with CMD on the use of conversational agent–enabled interventions. Joanna Briggs Institute critical appraisal tools will be used to evaluate the overall quality of evidence collected. Results: This review was initiated in May 2023 and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in June 2023, prior to title and abstract screening. Full-text screening of articles was completed in July 2023 and data extraction began August 2023. Final searches were conducted in April 2024 prior to finalizing the review and the manuscript was submitted for peer review in July 2024. Conclusions: This review will synthesize diverse observations pertaining to conversational agent–enabled intervention design features and their impacts on engagement among people with CMDs. These observations can be used to guide the development of more engaging conversational agent–enabled interventions, thereby increasing the likelihood of regular intervention use and improved CMD health outcomes. Additionally, this review will identify gaps in the literature in terms of how engagement is reported, thereby highlighting areas for future exploration and supporting researchers in advancing the understanding of conversational agent–enabled interventions. Trial Registration: PROSPERO CRD42023431579; https://tinyurl.com/55cxkm26
Background: Well-designed conversational agents can improve health care capacity to meet the dynamic and complex needs of people self-managing cardiometabolic diseases (CMD). However, a lack of empirical evidence on conversational agent–enabled intervention design features and their impact on engagement make it challenging to comprehensively evaluate effectiveness. This review synthesizes evidence on conversational agent–enabled intervention design features and how they impact on engagement to inform the development of more engaging conversational agent–enabled interventions that effectively help people with CMD to self-manage their condition. Objective: The aim of the study is to synthesize evidence pertaining to conversational agent–enabled intervention design features and their impact on engagement of people self-managing CMD. Methods: Searches were conducted in Ovid (MEDLINE), Web of Science, and Scopus databases. Inclusion criteria were primary research studies reporting on conversational agent–enabled interventions that included measures of engagement and included adults with CMD. Data extraction captured perspectives of people with CMD on various design features of conversational agent–enabled interventions. Results: Of 1366 studies identified for screening, 20 were included in the review. In total, 18 of these were qualitative or quasi-experimental evaluations of conversational agent–enabled intervention prototypes. Five domains of design features that impact user engagement with conversational agent–enabled interventions emerged: communication style, functionality, accessibility, visual appearance, and personality. Conclusions: Across all 5 domains, integrating redundancy and anthropomorphism were identified as effective strategies for improving engagement by increasing user autonomy and investment. Future research should adopt design strategies that are inclusive and adaptive to the diverse needs of users and aligned with the unique considerations relevant to conversational agent–enabled interventions. Trial Registration: PROSPERO CRD42023431579; https://tinyurl.com/3srmzw8f