Date of Award

8-1-2023

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Biomedical and Health Informatics

First Advisor

Jake Luo

Committee Members

Derek Nazareth, Jennifer T Fink, Min Wu

Keywords

Chatbot, Chatbot evaluation, Health information needs, Human papillomavirus vaccine, Social media analysis, Vaccine information

Abstract

The user-centered design approach is a process to outline the phases throughout a design and development cycle. It focuses on an explicit understanding of users, tasks, and environments and is driven by user-centered evaluation that addresses the user experience. In this dissertation, we conducted four studies to reach the main objective of designing a chatbot system that promotes health consumers with Human Papillomavirus vaccine information.Study one: Human Papillomavirus Vaccine Information on Social Media: A Literature Review This review highlights the studies’ findings on human papillomavirus (HPV) vaccine content on social media, and examines the use of social media in HPV vaccine promotion. Studies included in this review are restricted to those that discuss or promote knowledge about the HPV vaccine on a social media platform. A total of 25 studies were identified and retrieved from major electronic databases including PubMed, ScienceDirect, and Google Scholar. Articles ranged from analyzing social media content to reporting the outcomes of using social media as a tool for intervention or vaccination promotion campaigns. The majority of studies analyzed the types and frequencies of HPV vaccine-related social media content. Negative content exposure was associated with vaccine refusal, vaccination delay, lower HPV vaccination coverage, and an increased likelihood of sharing negative content with others in social media. Several studies concluded that social media platforms are an effective and trustworthy means of exchanging and discussing HPV vaccine information. However, the question of how social media affected HPV vaccination acceptance or rejection remains largely unexplored. Further examination is needed to analyze social media content about the HPV vaccine to identify approaches to effectively promote vaccination, acceptance, and increase the vaccination rate. Interventions should be initiated based on people's views and needs on social media to establish an effective approach to promote the HPV vaccine. Study two: Human Papillomavirus Vaccine Inquiries on Social Media: a Qualitative Study Approach The availability of health information on human papillomavirus (HPV) is crucial for promoting and enhancing HPV vaccination coverage. A lack of information often hinders health consumers from receiving the vaccine, which may negatively affect public health. This study aimed to investigate health consumer needs and understand information gaps in the HPV vaccine through a qualitative content analysis of social media posts. Using a purposive sampling strategy, we systematically leveraged and gathered HPV-vaccine-related questions to understand the current gaps and health consumers' needs from three social media platforms, Quora, Reddit, and Twitter. We only included questions about HPV infection and vaccine, and excluded any questions related to other vaccines. We retrieved 759 questions that met the inclusion criteria. The retrieved questions were analyzed and coded into eight major themes. These themes included the need for information, safety concerns, vaccination age variation, vaccine cost and insurance, parent-child decision and consent, vaccination location site, gender variation, and barriers and hesitation. Among these, the most dominant themes were the need for information (33.33%) and safety concerns (25.95%). In this study, we identified the major HPV vaccine information needs that should be focused on to provide health consumers with reliable and up-to-date information to promote and enhance HPV vaccination coverage to reach the national vaccination goal. The findings of this study have significant implications and establish the main baseline for developing a social media-based solution to mitigate information needs. The solution will answer the most common questions and increase health consumer understanding regarding the HPV vaccine to promote HPV vaccination. Study three: Development, Implementation, and Usability Evaluation of a Chatbot to Effectively Provide Information on the Human Papillomavirus Vaccine The Human papillomavirus (HPV) vaccine has been shown to provide protection against HPV infections, which can cause genital warts and some forms of cancer. Lack of information about the virus and the vaccine represents one of the major challenges to reaching national HPV vaccination goals. Advancements in natural language processing have facilitated the effectiveness of chatbots in interacting with users. Chatbots have been increasingly employed in health and medical care settings, assisting physicians during consultations, helping with behavior change issues, and supporting patients and the elderly in their daily lives. A potential opportunity to improve vaccination rates is to provide health information through unconventional methods by utilizing chatbots. This work describes the design, implementation, and evaluation of a chatbot called GARDI, created to disseminate information about HPV infection and vaccine. The Chatbot Usability Questionnaire (CUQ) was employed to evaluate GARDI. The mean CUQ score was 66.6, which is marginally below the suggested benchmark for evaluation of chatbots. An examination of CUQ subscales indicated that GARDI was considered to be easy to use and navigate, provided useful, appropriate, and informative responses, and welcoming in nature. Study four: Using a Chatbot to Promote Human Papillomaviruses Vaccine Information: User Experience and Feasibility Study The lack of Human papillomavirus (HPV) vaccine information hinders vaccine uptake, which challenges the HPV vaccination national coverage goal. Misleading information and unproven claims against the vaccine have increased healthcare practitioners' and parents' concerns regarding HPV vaccine safety and vaccination rates. In a previous study, we designed and presented GARDI chatbot, a chatbot to disseminate health information regarding HPV. We have based our design on a previous study's findings that examined health consumers' information needs about the vaccine by exploring questions posted on social media platforms. The aim of this study is to evaluate the chatbot against an HPV information brochure. For the evaluation, we relied on the following concepts: attractiveness, novelty, stimulation, visual aesthetics, and perceived knowledge. In addition, evaluating the usefulness of the chatbot components. The results indicated that the chatbot significantly outperformed the brochure in terms of attractiveness, novelty, and visual aesthetics. For both groups, when evaluating knowledge before and after administering both tools, the perceived knowledge evaluation was statistically significant. However, perceived knowledge was not significant when comparing the chatbot with the brochure. Based on these results, we determined that chatbots are a favorable means of disseminating HPV information. Chatbots provide the ability to design various features, availability and accessibility anywhere at any time, and easy updating and maintenance. We believe the use of chatbots will implicate better delivery of other health information.

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