Designing an Adaptive Embodied Conversational Agent for Health Literacy: a User Study

Access to healthcare advice is crucial to promote healthy societies. Many factors shape how access might be constrained, such as economic status, education or, as the COVID-19 pandemic has shown, remote consultations with health practitioners. Our work focuses on providing pre/post-natal advice to maternal women. A salient factor of our work concerns the design and deployment of embodied conversation agents (ECAs) which can sense the (health) literacy of users and adapt to scaffold user engagement in this setting. We present an account of a Wizard of Oz user study of 'ALTCAI', an ECA with three modes of interaction (i.e., adaptive speech and text, adaptive ECA, and non-adaptive ECA). We compare reported engagement with these modes from 44 maternal women who have differing levels of literacy. The study shows that a combination of embodiment and adaptivity scaffolds reported engagement, but matters of health-literacy and language introduce nuanced considerations for the design of ECAs.