Reducing social diabetes distress with a conversational agent support system: A three-week technology feasibility evaluation

Merijn Bruijnes, Mitchell Kesteloo, Willem-Paul Brinkman*

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Background: People with diabetes mellitus not only have to deal with physical health problems, but also with the psycho-social challenges their chronic disease brings. Currently, technological tools that support the psycho-social context of a patient have received little attention.

Objective: The objective of this work is to determine the feasibility and preliminary efficacy of an automated conversational agent to deliver, to people with diabetes, personalised psycho-education on dealing with (psycho-)social distress related to their chronic illness.

Methods: In a double-blinded between-subject study, 156 crowd-workers with diabetes received a social help program intervention in three sessions over three weeks. They were randomly assigned to receive support from either an interactive conversational support agent (n=79) or a self-help text from the book “Diabetes burnout” as a control condition (n=77). Participants completed the Diabetes Distress Scale (DDS) before and after the intervention, and after the intervention, the Client Satisfaction Questionnaire (CSQ-8), Feeling of Being Heard (FBH), and System Usability Scale (SUS).

Results: Results indicate that people using the conversational agent have a larger reduction in diabetes distress (M=−0.305, SD=0.865) than the control group (M=0.002, SD=0.743) and this difference is statistically significant (t(154)=2.377, p=0.019). A hypothesised mediation effect of “attitude to the social help program” was not observed.

Conclusions: An automated conversational agent can deliver personalised psycho-education on dealing with (psycho-)social distress to people with diabetes and reduce diabetes distress more than a self-help book.

Ethics, Study Registration and Open Science: This study has been preregistered with the Open Science Foundation ( and has been accepted by the Human Research Ethics Committee - Delft University of Technology under application number 1130. The data and analysis script are available:
Original languageEnglish
Article number1149374
Number of pages11
JournalFrontiers in Digital Health
Publication statusPublished - 2023


  • social diabetes distress
  • conversational agent
  • support system
  • personalised psych-education
  • self-help
  • longitudinal evaluation


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