User Autonomy Support in Automated E-Coaches

Autonomy is an increasingly relevant topic in medical health care, particularly when persuasive technology is used to influence the behavior of individuals. Persuasive applications inevitably nudge its users’ behavior in one direction or another, thus interfering to a certain extent with their autonomy. Despite having the users’ best interest in mind, autonomy is considered a basic psychological human need and right, meaning that excessive interference can be considered unethical. The purpose of this thesis has been to find ways in which to support the autonomy of the user while still retaining the benefits of persuasive technology. More specifically, we focus on E-Coaches, which are a type of persuasive application that take on the role of a social actor and aid its users in attaining sustainable behavior changes. A profound literature review was conducted to define autonomy in an integrated manner, resulting in four main postulates of autonomy. Furthermore, the literature review gave rise to the definition of three basic strategies for autonomy support. Subsequently, transcripts of therapy sessions of patients with primary insomnia were analyzed to discover speech act strategies related to the previously established basic strategies of autonomy support. The dialogue analysis revealed two additional autonomy support strategies that were dubbed supplementary strategies. For each of the five categories, several sub-strategies were discovered in the transcripts. Finally, the speech act strategies were applied to SleepCare, a mobile E-Coach for individuals with insomnia, so as to illustrate how the strategies could be applied in practice. The five strategies constitute a major step towards a framework for autonomy support in persuasive applications. However, it may be reasonable to at least not discard the possibility of additional strategies existing. The sub-strategies are not intended to be interpreted as an exhaustive list of possible autonomy support methods. Rather, they represent an empirical account of autonomy support strategies employed by a sleep therapist, seen from the perspective of a persuasive application that delivers cues through natural language