Development and evaluation of a smartphone-based chatbot coach to facilitate a balanced lifestyle in individuals with headaches (BalanceUP App) : randomized controlled trial

Ulrich, Sandra; Gantenbein, Andreas R.; Zuber, Viktor; von Wyl, Agnes; Kowatsch, Tobias; Künzli, Hansjörg

doi:10.2196/50132

Please use this identifier to cite or link to this item: https://doi.org/10.21256/zhaw-29684

Publication type:	Article in scientific journal
Type of review:	Open peer review
Title:	Development and evaluation of a smartphone-based chatbot coach to facilitate a balanced lifestyle in individuals with headaches (BalanceUP App) : randomized controlled trial
Authors:	Ulrich, Sandra Gantenbein, Andreas R. Zuber, Viktor von Wyl, Agnes Kowatsch, Tobias Künzli, Hansjörg
et. al:	No
DOI:	10.2196/50132 10.21256/zhaw-29684
Published in:	Journal of Medical Internet Research
Volume(Issue):	26
Page(s):	e50132
Issue Date:	24-Jan-2024
Publisher / Ed. Institution:	JMIR Publications
ISSN:	1438-8871
Language:	English
Subjects:	Behavior change; Lifestyle; mHealth; Mental well-being; Mobile health; Psychoeducation; Relaxation; Smartphone; Headache; Migraine; Conversational agent; Tension-type-headache
Subject (DDC):	613: Personal health 616.8: Neurology, diseases of nervous system
Abstract:	Background: Primary headaches, including migraine and tension-type headaches, are widespread and have a social, physical, mental, and economic impact. Among the key components of treatment are behavior interventions such as lifestyle modification. Scalable conversational agents (CAs) have the potential to deliver behavior interventions at a low threshold. To our knowledge, there is no evidence of behavioral interventions delivered by CAs for the treatment of headaches. Objective: This study has 2 aims. The first aim was to develop and test a smartphone-based coaching intervention (BalanceUP) for people experiencing frequent headaches, delivered by a CA and designed to improve mental well-being using various behavior change techniques. The second aim was to evaluate the effectiveness of BalanceUP by comparing the intervention and waitlist control groups and assess the engagement and acceptance of participants using BalanceUP. Methods: In an unblinded randomized controlled trial, adults with frequent headaches were recruited on the web and in collaboration with experts and allocated to either a CA intervention (BalanceUP) or a control condition. The effects of the treatment on changes in the primary outcome of the study, that is, mental well-being (as measured by the Patient Health Questionnaire Anxiety and Depression Scale), and secondary outcomes (eg, psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presenteeism and absenteeism, and pain coping) were analyzed using linear mixed models and Cohen d. Primary and secondary outcomes were self-assessed before and after the intervention, and acceptance was assessed after the intervention. Engagement was measured during the intervention using self-reports and usage data. Results: A total of 198 participants (mean age 38.7, SD 12.14 y; n=172, 86.9% women) participated in the study (intervention group: n=110; waitlist control group: n=88). After the intervention, the intention-to-treat analysis revealed evidence for improved well-being (treatment: β estimate=–3.28, 95% CI –5.07 to –1.48) with moderate between-group effects (Cohen d=–0.66, 95% CI –0.99 to –0.33) in favor of the intervention group. We also found evidence of reduced somatic symptoms, perceived stress, and absenteeism and presenteeism, as well as improved headache management self-efficacy, application of behavior change techniques, and pain coping skills, with effects ranging from medium to large (Cohen d=0.43-1.05). Overall, 64.8% (118/182) of the participants used coaching as intended by engaging throughout the coaching and completing the outro. Conclusions: BalanceUP was well accepted, and the results suggest that coaching delivered by a CA can be effective in reducing the burden of people who experience headaches by improving their well-being. Trial Registration: German Clinical Trials Register DRKS00017422; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00017422
URI:	https://digitalcollection.zhaw.ch/handle/11475/29684
Fulltext version:	Published version
License (according to publishing contract):	CC BY 4.0: Attribution 4.0 International
Departement:	Applied Psychology
Organisational Unit:	Psychological Institute (PI)
Appears in collections:	Publikationen Angewandte Psychologie

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Ulrich, S., Gantenbein, A. R., Zuber, V., von Wyl, A., Kowatsch, T., & Künzli, H. (2024). Development and evaluation of a smartphone-based chatbot coach to facilitate a balanced lifestyle in individuals with headaches (BalanceUP App) : randomized controlled trial. Journal of Medical Internet Research, 26, e50132. https://doi.org/10.2196/50132

Ulrich, S. et al. (2024) ‘Development and evaluation of a smartphone-based chatbot coach to facilitate a balanced lifestyle in individuals with headaches (BalanceUP App) : randomized controlled trial’, Journal of Medical Internet Research, 26, p. e50132. Available at: https://doi.org/10.2196/50132.

S. Ulrich, A. R. Gantenbein, V. Zuber, A. von Wyl, T. Kowatsch, and H. Künzli, “Development and evaluation of a smartphone-based chatbot coach to facilitate a balanced lifestyle in individuals with headaches (BalanceUP App) : randomized controlled trial,” Journal of Medical Internet Research, vol. 26, p. e50132, Jan. 2024, doi: 10.2196/50132.

ULRICH, Sandra, Andreas R. GANTENBEIN, Viktor ZUBER, Agnes VON WYL, Tobias KOWATSCH und Hansjörg KÜNZLI, 2024. Development and evaluation of a smartphone-based chatbot coach to facilitate a balanced lifestyle in individuals with headaches (BalanceUP App) : randomized controlled trial. Journal of Medical Internet Research. 24 Januar 2024. Bd. 26, S. e50132. DOI 10.2196/50132

Ulrich, Sandra, Andreas R. Gantenbein, Viktor Zuber, Agnes von Wyl, Tobias Kowatsch, and Hansjörg Künzli. 2024. “Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals with Headaches (BalanceUP App) : Randomized Controlled Trial.” Journal of Medical Internet Research 26 (January): e50132. https://doi.org/10.2196/50132.

Ulrich, Sandra, et al. “Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals with Headaches (BalanceUP App) : Randomized Controlled Trial.” Journal of Medical Internet Research, vol. 26, Jan. 2024, p. e50132, https://doi.org/10.2196/50132.