Effects of digital chatbot on gender attitudes and exposure to intimate partner violence among young women in South Africa.
Effects of digital chatbot on gender attitudes and exposure to intimate partner violence among young women in South Africa.
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DOI：
10.1371/journal.pdig.0000358
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发表时间：
2023-10
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南非是全球亲密伴侣暴力（IPV）发生率最高的国家之一，由于性别角色不平等，关系技能有限和社会支持不足，年轻女性面临的风险更高。尽管迫切需要在低收入和中等收入环境中预防暴力，但最有效的方法都需要大量时间，而且实施成本高。数字互动聊天机器人可以帮助年轻女性建立更安全的关系，并培养更健康的性别信念和技能南非的年轻女性（18-24岁）通过Facebook招募参加2021年6月至2021年9月期间的一项单独随机对照试验（n = 19，643）。使用管道算法将用户随机分配到四个试验组中的一个：纯控制（PC）在研究措施之外没有用户参与;注意力治疗（T0）通过基于文本的聊天机器人提供有关性健康的教学信息;游戏化治疗（T1）是一个行为知情的游戏化文本聊天机器人;叙事治疗（T2）是通过预先录制的语音笔记提供的行为知情的戏剧。所有聊天机器人都在WhatsApp中交付，通过WhatsApp，用户被邀请完成简短的“测验”，其中包括经过验证的量表的改编版本。主要结果是性别态度量表（性别关系量表）和上个月IPV（世卫组织多国研究工具）的简短改编。次要结果是识别不健康的关系行为（亲密伴侣暴力态度量表）和抑郁症状的简短筛选（患者健康问卷）。与训练有素的顾问直接聊天链接是一种安全措施（4.5%的样本访问）。我们使用普通最小二乘法和异方差稳健标准误估计治疗效果。试验保留了11，630例（59.2%）患者的性别态度作为主要终点。与对照组相比，所有治疗导致对更大的性别平等的态度的中度和显着的变化（科恩的D = 0.10，0.29，0.20 T0，T1和T2，分别）。游戏化聊天机器人（T1）对IPV有适度但显著的影响：56%的年轻女性报告了上个月的IPV，而没有接受治疗的女性为62%（边际效应=-0.07，95%CI =-0.09至-0.05）。叙述治疗（T2）对IPV暴露无影响。T1在中等和显著水平上增加了对不健康关系行为的识别（科恩D = 0.25）。无论是T1还是T2对抑郁症状都没有可测量的影响，这是由简短的筛选器测量的。释义：一个行为上知情的游戏化聊天机器人提高了性别平等的态度，并保护了南非年轻女性的IPV暴露。这些影响虽然规模不大，但鉴于有可能扩大低成本干预措施的规模，可能会产生有意义的影响。亲密伴侣暴力（IPV）影响到全世界三分之一的妇女，并损害健康和福祉。然而，很少有低成本的方法被证明可以预防IPV。我们测试了数字互动聊天机器人是否可以通过改变态度和技能来帮助南非的年轻女性保持安全。我们将相似的年轻女性分配到两个聊天机器人中的一个。第一个是游戏化的（通过Whatsapp聊天的表情符号和小任务）。第二个是叙事（使用Whatsapp语音笔记预先录制的故事）。他们的反应与随机分配到控制组的年轻女性进行了比较，控制组只接收信息或根本没有聊天机器人。游戏化和叙事聊天机器人都改善了年轻女性的态度，提高了识别不健康关系的技能。游戏化的聊天机器人在三个月后才降低了IPV。这是减少IPV暴露的首批数字方法之一。
South Africa has among the highest rates of intimate partner violence (IPV) globally, with young women at heightened risk due to inequitable gender roles, limited relationship skills, and inadequate social support. Despite an urgent need for violence prevention in low- and middle-income settings, most efficacious approaches are time-intensive and costly to deliver. Digital, interactive chatbots may help young women navigate safer relationships and develop healthier gender beliefs and skills Young women (18–24 years old) across South Africa were recruited via Facebook for participation in an individually randomised controlled trial (n = 19,643) during the period of June 2021-September 2021. Users were randomly allocated, using a pipeline algorithm, to one of four trial arms: Pure Control (PC) had no user engagement outside of study measures; Attention Treatment (T0) provided didactic information about sexual health through a text-based chatbot; Gamified Treatment (T1) was a behaviourally-informed gamified text-based chatbot; Narrative Treatment (T2) was a behaviourally-informed drama delivered through pre-recorded voice notes. All chatbots were delivered in WhatsApp, through which users were invited to complete brief “quizzes” comprising adapted versions of validated scales. Primary outcomes were short-form adaptations of scales for gender attitudes (Gender Relations Scale) and past-month IPV (WHO Multi-country Study Instrument). Secondary outcomes were identification of unhealthy relationship behaviours (Intimate Partner Violence Attitudes Scale) and brief screener for depressive symptoms (Patient Health Questionnaire). A direct chat link to a trained counsellor was a safety measure (accessed by 4.5% of the sample). We estimated treatment effects using ordinary least squares and heteroskedasticity robust standard errors The trial retained 11,630 (59.2%) to the primary endpoint of gender attitudes. Compared to control, all treatments led to moderate and significant changes in attitudes towards greater gender equity (Cohen’s D = 0.10, 0.29, 0.20 for T0, T1, and T2, respectively). The gamified chatbot (T1) had modest but significant effects on IPV: 56% of young women reported past-month IPV, compared to 62% among those without treatment (marginal effects = -0.07, 95%CI = -0.09to-0.05). The narrative treatment (T2) had no effect on IPV exposure. T1 increased identification of unhealthy relationship behaviours at a moderate and significant level (Cohen’s D = 0.25). Neither T1 nor T2 had a measurable effect on depressive symptoms as measured by the brief screener. Interpretation: A behaviourally-informed, gamified chatbot increased gender equitable attitudes and was protective for IPV exposure among young women in South Africa. These effects, while modest in magnitude, could represent a meaningful impact given potential to scale the low-cost intervention. Intimate partner violence (IPV) affects one in three women worldwide and harms health and well-being. Yet, there are few low-cost ways proven to prevent IPV. We tested if digital, interactive chatbots could help young women across South Africa stay safer by changing their attitudes and skills. We assigned similar young women to one of two chatbots. The first was gamified (with emojis and small tasks through Whatsapp chat). The second was narrative (with a story pre-recorded using Whatsapp voice notes). Their responses were compared to young women randomly assigned to a control group that received information-only or no chatbot at all. Both gamified and narrative chatbots improved young women’s attitudes and increased skills in identifying unhealthy relationship. The gamified chatbot only reduced IPV after three months. This is one of the first digital approaches to decrease IPV exposure.