Initial progress toward development of a voice-based computer-delivered motivational intervention for heavy drinking college students: An experimental study

Abstract

Background: Computer-delivered interventions have been shown to be effective in reducing alcohol consumption in heavy drinking college students. However, these computer-delivered interventions rely on mouse, keyboard, or touchscreen responses for interactions between the users and the computer-delivered intervention. The principles of motivational interviewing suggest that in-person interventions may be effective, in part, because they encourage individuals to think through and speak aloud their motivations for changing a health behavior, which current computer-delivered interventions do not allow. Objective: The objective of this study was to take the initial steps toward development of a voice-based computer-delivered intervention that can ask open-ended questions and respond appropriately to users' verbal responses, more closely mirroring a human-delivered motivational intervention. Methods: We developed (1) a voice-based computer-delivered intervention that was run by a human controller and that allowed participants to speak their responses to scripted prompts delivered by speech generation software and (2) a text-based computer-delivered intervention that relied on the mouse, keyboard, and computer screen for all interactions. We randomized 60 heavy drinking college students to interact with the voice-based computer-delivered intervention and 30 to interact with the text-based computer-delivered intervention and compared their ratings of the systems as well as their motivation to change drinking and their drinking behavior at 1-month follow-up. Results: Participants reported that the voice-based computer-delivered intervention engaged positively with them in the session and delivered content in a manner consistent with motivational interviewing principles. At 1-month follow-up, participants in the voice-based computer-delivered intervention condition reported significant decreases in quantity, frequency, and problems associated with drinking, and increased perceived importance of changing drinking behaviors. In comparison to the text-based computer-delivered intervention condition, those assigned to voice-based computer-delivered intervention reported significantly fewer alcohol-related problems at the 1-month follow-up (incident rate ratio 0.60, 95% CI 0.44-0.83, P=.002). The conditions did not differ significantly on perceived importance of changing drinking or on measures of drinking quantity and frequency of heavy drinking. Conclusions: Results indicate that it is feasible to construct a series of open-ended questions and a bank of responses and follow-up prompts that can be used in a future fully automated voice-based computer-delivered intervention that may mirror more closely human-delivered motivational interventions to reduce drinking. Such efforts will require using advanced speech recognition capabilities and machine-learning approaches to train a program to mirror the decisions made by human controllers in the voice-based computer-delivered intervention used in this study. In addition, future studies should examine enhancements that can increase the perceived warmth and empathy of voice-based computer-delivered intervention, possibly through greater personalization, improvements in the speech generation software, and embodying the computer-delivered intervention in a physical form.