The Journal of mHealth Vol 3 Issue 2 (Apr/May 2016) | Page 32

Artificial Intelligence Is Your Healthcare Companion

Artificial Intelligence Is Your Healthcare Companion

Artificial Intelligence Is Your
Healthcare Companion
By Thomas Sutton, Executive Creative
Director, Frog

Unfortunately, simply explaining this to
people is not an effective way to change
behaviour.

Artificial Intelligence (AI) promises
everything from self-driving cars to selfwriting newspapers, but AI may be missing its greatest opportunity in healthcare.
Many healthcare companies are working
on AI solutions that augment or transform the work of healthcare professionals, but AI-driven “conversational
interfaces” hold untapped potential to
influence the health and wellbeing of billions of people.
Fuelled by the massive popularity of
messaging platforms such as WhatsApp,
“conversational UI” is providing an
emerging generation of chat-based digital services that may be the next thing in
consumer technology. Instead of manipulating a graphical interface, users have
a conversation with a chat-bot: software
that is able to understand and respond
to natural language inputs. The pace of
technical advances combined with a shift
in cultural norms is making AI conversations feel normal for increasing numbers
of people.
The rise (or return) of conversational
interfaces
The idea of a "computer you can talk
to" has captured the imagination of the
computer science community, and the
general public, for decades. Great science
fiction characters such as HAL 9000 from
2001:Space Odyssey and Samantha from
Her have explored the promise and the
risks of this idea. But real-life consumer
experiences have tended more towards
the comical, perhaps best represented
by the “clippy” assistant for Microsoft
Office. However, in the last five years
leading technology brands have driven
a broader acceptance of conversational
interfaces within everyday life: Apple
was an early mover with Siri; Google followed with Google Now; Amazon took a
slightly different approach with the Echo.
More representative of the current crop
of text-based assistants is Facebook M,
a general-purpose virtual assistant

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April/May 2016

In designing solutions to help people
improve and manage their health, we
consistently find that people’s actions are
not driven primarily by rational decisionmaking. Whether you are a market-farmer
in Malawi or a bus-driver in Liverpool,
the behaviours that impact your health
are largely driven by feelings, beliefs, social
and physical context, habits and addictions, and irrational ways of thinking
about risks and benefits. Only by addressing all of these layers, we can achieve lasting and scalable behavioural change.

that “lives” in Facebook messenger and
is currently in beta-testing in the US.
Unlike Siri, M is not voice-powered, but
it is able to sustain extended conversations and perform complex tasks, like
purchasing products online. Facebook
isn’t releasing details about how the technology works, but admits that the AI is
still being “trained” by human operators.
There are also many simpler and more
specialised chat-based services – and as
one might expect, there are a number of
companies working on the “AI doctor”,
including Babylon Health in the UK.
Designing with AI for Behaviour
Change
To a surprisingly large degree, poor health
depends on the choices we make in our
daily lives – the excess of food, drink, and
drugs we consume, insufficient physical
activity and sleep, high stress and low
attention to our wellbeing. These are the
biggest risk factors for non-communicable diseases (NCDs); they are the main
drivers of ill-health and healthcare costs
in high and middle-income countries.

One of the most powerful methods to do
this is through coaching or motivational
interviews. Building on psychological
theories of behaviour change, these techniques rely on a sequence of conversations
that gradually unlock an individual’s selfbelief, commitment, and capability to
change. This process has been proven to
work across diverse fields from weightloss to alcoholism, but it can take months
or years to work and is typically mediated
by specialised counsellors or coaches.
Scaling this method to millions of people
is prohibitively expensive.

kids. Once they’re in bed, she can finally
unwind with a bottle of wine and a cigarette before snatching a few hours rest to
then start the cycle once again.
The last thing anyone should do is pass
judgement on Jane, yet she’s bombarded
with judgemental messages. “Jane, you
should lose some weight”, “Jane, you
should get some exercise”, “Jane, you
should cut back on the drinks.” While
these messages may be well-intentioned,
they undermine her self-compassion and
do nothing to help her take concrete
actions to improve her health.
Jane, meet Sara.
One evening, as Jane is catching up with
friends online, she’s attracted by a different kind of message in her Facebook
feed. It emphasises her importance as
the epicentre of her family, resonating
with her deep sense of responsibility as
a mother. Unbeknownst to her, this message had been tailored and presented to
her by an algorithm based on her browsing history.
She clicks to see what it’s about. Instead
of the usual click-bait, this initiates a

chat with a health-bot, Sara, who starts
by asking her how she feels.
“Wow, how do I feel?” she wonders.
“How long has it been since someone
asked me that and was really interested
in the answer?”
Somehow, the fact that Sara is a bot
doesn’t inhibit the conversation. In fact,
Jane feels freer to be honest about her
feelings and aspirations knowing that a
bot can’t pass a moral judgement.
Behind the scenes, Sara is following a
dynamic conversation script based on
proven behaviour change models. First,
it focuses on Jane’s aspirations. Then
it helps her to reflect on how her lifestyle impacts her wellbeing. Finally, it
encourages her to choose some simple
actions that she feels can be successfully
integrated into her daily routine. Jane
chooses to substitute deserts with fresh
fruit, have two alcohol-free days a week
and go for a bike-ride on the weekend.
These are small steps. On their own they
might not radically change her health
risk, but achieving them will do wonders for her self-esteem, mental wellbeing, and sense of control – all of which

Over the next days and weeks, Sara stays
in touch via messenger, checking in to
see how Jane is doing, providing tips and
encouragement. After each success, Sara
gently suggests a next step. And after
each set-back, Sara is infinitely understanding and kind. Through this process,
Jane is also learning to be kinder to herself – and the biggest surprise for her is
how much better she feels, mentally and
emotionally.
Jane is on a new trajectory that significantly reduces her risk of stroke, heart
attack, diabetes, and depression, but
fear and risk were never part of the
conversation.
Fact or fiction?
Jane is real. We’ve met her – and many
others like her – while conducting design
research around the world. She possesses
the capability to change her own life, and
we have witnessed first-hand how these
capabilities can be unlocked through this
kind of conversational intervention.
Sara is real too. She is to be found in the
many nurses, community health workers and wellness coaches who, whether
through formal training or trial and
error, have found the right conversational techniques to make a connection
with people like Jane.
The onus is now on us. The community
of digital health innovators, to seize the
opportunity provided by AI and conversational interfaces and deliver these
kinds of interventions at scale. A handful of trailblazers are leading the way
and achieving remarkable clinical results
– from Pear Therapeutics for addiction
therapy, to ginger.io for depression, to
AmicoMed for hypertension. Meanwhile
the heavyweights of AI, Google and IBM
Watson, are collaborating with telehealth
companies like Babylon and Talkspace
to “train” their algorithms based on
thousands of chat records with real-life
coaches. However, so far we are only
scratching the surface.

This is where emerging AI technologies
and user-interfaces that enable realistic
and sophisticated conversations with
computers provide a specific opportunity. It is an opportunity to leverage
what we already know and accept about
behaviour change and apply it together
with AI to engage people in meaningful conversations about their health. It is
also an opportunity to help people live
healthier lives on a scale that has never
before been possible.
Meet Jane
You probably already know Jane. She
lives in the London suburbs and commutes on the tube for an hour to arrive
at her job as an administrative assistant.
When she gets home, she orders dinner
from a delivery service or prepares something quick in the frying-pan for her

are essential for larger changes to come.
Jane leaves the chat feeling energized and
committed to change.

Preventable Risk Factors in the UK

According to Public Health England, “Known potentially preventable risk factors taken together explain 40% of ill health in England. If you examine the impact of specific risks on
the overall disease burden, unhealthy diet and tobacco are the two largest contributors ‡
(diet accounts for 10.8% of total disease burden and tobacco 10.7%).” [1, 2]

A moral imperative
The techniques described here, if put to
Continued on page 32

The Journal of mHealth

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