Developing an Optimized Conversational Agent or "Chatbot" to Facilitate Mental Health Services Use in Individuals with Eating Disorders

项目摘要/摘要 进食障碍(Eds)是一种严重的精神疾病，具有很高的发病率和死亡率。 精神损害和共病的精神病理。尽管对急症的循证治疗一直是 已经建立起来的，治疗差距很大。事实上，20%的EDS患者接受了治疗。我们需要一个 新的解决方案不仅可以识别患有精神障碍的个体，还可以鼓励精神健康服务的使用和 解决治疗障碍。我已经与全国EDS协会建立了牢固的工作关系 (NEDA)，美国领先的EDS非营利性组织S，在 NEDA网站。在一年多的时间里，NEDA屏幕完成了20万次。在屏幕受访者中， 绝大多数ED筛查呈阳性，但在这些人中，大多数没有接受治疗，只有一小部分人 点击百分比了解有关筛查中显示的寻求干预的选项之一的详细信息 反馈。我提出了一个研究议程，以设计一个对话代理或“聊天机器人”，它被优化为 通过以下功能增加精神障碍患者的心理健康服务使用量：1)提供 寻求干预的个性化推荐；2)让用户参与激励性访谈，以 克服护理障碍；以及3)反复与用户签到，以鼓励后续护理。这 研究议程与NIMH对服务研究的关注和对技术驱动方法的兴趣相一致 以促进与关怀的接触。我会进行两项研究。首先，我将使用以用户为中心的设计 创建聊天机器人原型并与患有ED的成年人进行可用性测试以告知聊天机器人的方法 改进(目标1)。其次，我将对已经完成的成年人进行随机优化试验 在NEDA网站上进行筛查，筛查出ED阳性，但未接受治疗以确定聊天机器人 可行性和生成关于聊天机器人对最初使用聊天机器人后的治疗动机的影响的数据 在1个月和3个月的随访中使用治疗和心理健康服务的动机(目标2和3)。这 试验将采用多阶段优化策略框架，使用23个完全析因设计，以随机 将参与者分配给三个建议干预组件的组合(n=8个条件)以隔离 活性成分。这些目标支持我的培训计划，在该计划中，我将接受专家指导和 培训：服务研究和实施科学(培训目标1)；以用户为中心的设计和 可用性测试，以及接触机器学习(培训目标2)；新的试验设计(培训目标 3)以及分析纵向试验和数字创新数据的高级统计技术(培训 目标4)。我的专家指导团队以及华盛顿大学的环境将确保我的 成功。建议的研究结果将用于优化聊天机器人，然后我将在 随后的R01随机对照试验。这个K08将使我具备成为一名领导者的技能 解决急诊室的研究-实践和治疗差距，重点是数字创新。

PROJECT SUMMARY/ABSTRACT Eating disorders (EDs) are serious mental illnesses associated with high morbidity and mortality, clinical impairment, and comorbid psychopathology. Although evidence-based treatments for EDs have been established, the treatment gap is wide. Indeed, <20% of individuals with EDs receive treatment. We need a novel solution not only to identify individuals with EDs but also to encourage mental health services use and address treatment barriers. I have established a strong working relationship with the National EDs Association (NEDA), the U.S.'s leading non-profit for EDs, to offer our group's online, evidence-based EDs screen on the NEDA website. Over one year, the NEDA screen was completed >200,000 times. Among screen respondents, the vast majority screen positive for an ED, but of those, most are not in treatment, and only a small percentage click to learn more about one of the options for seeking intervention presented in the screening feedback. I propose a research agenda to design a conversational agent or “chatbot” that is optimized to increase mental health services use among individuals with EDs through such features as: 1) providing a personalized recommendation for seeking intervention; 2) engaging the user in motivational interviewing to overcome barriers to care; and 3) repeated check-ins with the user to encourage follow-up with care. This research agenda aligns with NIMH's focus on services research and interest in technology-driven approaches to promote engagement with care. I will conduct two studies. First, I will utilize a user-centered design approach to create a prototype chatbot and conduct usability testing with adults with EDs to inform chatbot refinements (Aim 1). Second, I will conduct a randomized optimization trial with adults who have completed screening on the NEDA website and screen positive for an ED but are not in treatment to determine chatbot feasibility and to generate data on the effect of the chatbot on motivation for treatment post-initial chatbot use and motivation for treatment and mental health services use at 1- and 3-month follow-ups (Aims 2 & 3). This trial will employ the Multiphase Optimization Strategy framework, using a 23 full factorial design, to randomly assign participants to a combination of the three proposed intervention components (n=8 conditions) to isolate the active ingredients. These aims support my training plan in which I will receive expert mentorship and training in: services research and implementation science (Training Goal 1); user-centered design and usability testing, as well as exposure to machine learning (Training Goal 2); novel trial designs (Training Goal 3); and advanced statistical techniques for analyzing longitudinal trial and digital innovation data (Training Goal 4). My expert mentorship team, along with the environment of Washington University, will ensure my success. Results from the proposed study will be used to optimize the chatbot, which I will then test in a subsequent R01 randomized controlled trial. This K08 will equip me with the skills to become a leader in addressing the research-practice and treatment gaps for EDs, with a focus on digital innovations.