Can a monologue-style ECA more effectively motivate eHealth users in initial distress than textual guidance?

Mark R. Scholten*, Saskia M. Kelders, Julia E.W.C. Van Gemert-Pijnen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
45 Downloads (Pure)


Stress is a prevalent issue amongst patients with chronic conditions. As eHealth interventions are gaining importance, it becomes more relevant to invoke the possibilities from the eHealth technology itself to provide motivational acts during experiences of stress as to enhance adherence to the intervention. Embodied Conversational Agents (ECA's) also known as ‘robots on screen’ can potentially provide a remedy. Within our eHealth experiment we applied a between-subjects design and experimentally studied the difference in appraisal of motivation and guidance. We deployed a functionally modest, monologue-style ECA and compared them with textual guidance. This way, we filtered out the considerable positive impact of interactive features that go along with dialogue-style ECA's. The study was carried out amongst eHealth users of which half were deliberately put in a stressful pre-condition. The rationale was two-sided; first, we hypothesized that it would induce a need for motivational support. Second, it would provide a fair representation of eHealth users in real life. Furthermore, we investigated hypothesized positive effects from a gender match between participant and ECA. The results demonstrated preferential ECA effects compared to text but only in the no stress conditions. Although our set-up controlled for user distraction by putting the facilitating ECA in a pane separate from the eHealth environment, we suspect that the enduring visual presence of the ECA during task completion had still inhibited distressed users. Discussing this phenomenon, our stance is that the hypothesis that ECA support is always superior to textual guidance is open for re-evaluation. Text may sometimes serve users equally well because it lacks human-like aspects that in stressful circumstances can become confrontational. We discuss the potential of ECA's to motivate, but also elaborate on the caveats. Further implications for the ECA, intervention adherence, and eHealth study fields are discussed in relation to stress.

Original languageEnglish
Article numbere06509
Number of pages11
Issue number3
Publication statusPublished - 21 Mar 2021


  • Affective computing
  • eHealth
  • Embodied conversational agent
  • Persuasive technology
  • Stress
  • Support


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