How should a virtual agent present psychoeducation? Influence of verbal and textual presentation on adherence

Myrthe Tielman, Mark Neerincx, Marieke van Meggelen, Ingmar Franken, Willem-Paul Brinkman

Research output: Contribution to journalArticleScientificpeer-review

36 Citations (Scopus)
68 Downloads (Pure)


With the rise of autonomous e-mental health applications, virtual agents can play a major role in improving trustworthiness, therapy outcome and adherence. In these applications, it is important that patients adhere in the sense that they perform the tasks, but also that they adhere to the specific recommendations on how to do them well. One important construct in improving adherence is psychoeducation, information on the why and how of therapeutic interventions. In an e-mental health context, this can be delivered in two different ways: verbally by a (virtual) embodied conversational agent or just via text on the screen. The aim of this research is to study which presentation mode is preferable for improving adherence.

METHODS: This study takes the approach of evaluating a specific part of a therapy, namely psychoeducation. This was done in a non-clinical sample, to first test the general constructs of the human-computer interaction. We performed an experimental study on the effect of presentation mode of psychoeducation on adherence. In this study, we took into account the moderating effects of attitude towards the virtual agent and recollection of the information. Within the paradigm of expressive writing, we asked participants (n=n= 46) to pick one of their worst memories to describe in a digital diary after receiving verbal or textual psychoeducation.

We found that both the attitude towards the virtual agent and how well the psychoeducation was recollected were positively related to adherence in the form of task execution. Moreover, after controlling for the attitude to the agent and recollection, presentation of psychoeducation via text resulted in higher adherence than verbal presentation by the virtual agent did.
Original languageEnglish
Pages (from-to)1081-1096
Number of pages16
JournalTechnology and Health Care: official journal of the European Society for Engineering and Medicine
Issue number6
Publication statusPublished - 17 Oct 2017


  • Virtual health agent
  • expressive writing
  • mode of presentation
  • persuasion
  • adherence
  • psychoeducation
  • relational agent
  • e-health
  • e-mental health
  • conversational agent


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