BACKGROUND
Adults with Diabetes Mellitus (DM) present difficulties in maintaining healthy behaviors, in which motivation represents a core component, since it allows them to adhere to clinical recommendations. Virtual Coaches (VCs) have recently become more relevant in supporting and treating common barriers associated with adherence among adults with DM, especially concerning medical and physical aspects. However, few VCs are aimed at supporting adults with DM from a psychosocial perspective.
OBJECTIVE
This proof-of-concept study aimed to evaluate—at pre-, post-intervention and follow-up—the preliminary efficacy of a VC intervention in motivating adults with DM to reduce depression, anxiety, perceived stress symptoms, diabetes-emotional distress, and improve their well-being, by encouraging them to adopt psychosocial healthy coping strategies. In addition, users’ experience and engagement with a VC were assessed.
METHODS
A total of 13 Italian adults with DM (18-51 years) were recruited using snowball sampling via social media and a standardized psychosocial tools battery was applied at pre-, post-intervention, and follow-up. Participation in the study implied having access to a VC called Motibot, which stands for Motivational bot, within the Telegram application, based on Natural Language Understanding (NLU). Its intent is to motivate the user to adopt and cultivate healthy coping strategies based on the American Association of Diabetes Educators’ (AADE) guidelines as well as on Mindfulness-Based Cognitive Therapy. Motibot interacts with users in compliance with the Transtheoretical Model of Change, in order to deliver the most appropriate psychoeducational intervention tailored to the user's motivation to change. The interaction covered 12 sessions—each one lasting 10-20 minutes—during which the user could dialogue with the VC by inputting text or tapping an option on their smartphone screen.
RESULTS
Over the 12 sessions there were no significant changes at pre-, post-intervention, and follow-up concerning the psychosocial factors. However, most users showed a downward trend over the three time periods in depression and anxiety symptoms—except for perceived stress symptoms, which remained moderate for the whole intervention—thereby presenting good psychological well-being and no diabetes-emotional distress. Moreover, users felt motivated, involved, encouraged, emotionally understood, and stimulated by Motibot during the interaction. Indeed, the analyses of interviews through a text mining approach confirmed that Motibot is capable of supporting and motivating adults with DM to adopt healthy coping strategies and reduce anxiety, depression, and perceived stress symptoms. Users also reported having a positive and interesting experience with Motibot, particularly regarding the mindfulness audio tracks and the encouragement for self-reflection on their own emotions.
CONCLUSIONS
A VC developed using NLU was well-accepted by users, particularly due to the presence of a mindfulness pathway, which motivated them to adopt healthy coping skills. Cultivating healthy coping strategies allows adults to reduce anxiety and depression symptoms as well as diabetes-related emotional distress, and to improve their well-being.
Meal Enjoyment and Tolerance in Women and Men