Embodied conversational agent appearance for health assessment of older adults: Explorative study

Silke ter Stal*, Marijke Broekhuis, Lex van Velsen, Hermie Hermens, Monique Tabak

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
14 Downloads (Pure)


Background: Embodied conversational agents (ECAs) have great potential for health apps but are rarely investigated as part of such apps. To promote the uptake of health apps, we need to understand how the design of ECAs can influence the preferences, motivation, and behavior of users.

Objective: This is one of the first studies that investigates how the appearance of an ECA implemented within a health app affects users' likeliness of following agent advice, their perception of agent characteristics, and their feeling of rapport. In addition, we assessed usability and intention to use.

Methods: The ECA was implemented within a frailty assessment app in which three health questionnaires were translated into agent dialogues. In a within-subject experiment, questionnaire dialogues were randomly offered by a young female agent or an older male agent. Participants were asked to think aloud during interaction. Afterward, they rated the likeliness of following the agent's advice, agent characteristics, rapport, usability, and intention to use and participated in a semistructured interview.

Results: A total of 20 older adults (72.2 [SD 3.5] years) participated. The older male agent was perceived as more authoritative than the young female agent (P=.03), but no other differences were found. The app scored high on usability (median 6.1) and intention to use (median 6.0). Participants indicated they did not see an added value of the agent to the health app.

Conclusions: Agent age and gender little influence users' impressions after short interaction but remain important at first glance to lower the threshold to interact with the agent. Thus, it is important to take the design of ECAs into account when implementing them into health apps.

Original languageEnglish
Article numbere19987
JournalJMIR human factors
Issue number3
Publication statusPublished - Jul 2020


  • Appearance design
  • EHealth
  • Embodied conversational agent
  • Health status assessment
  • Older adults


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