{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:34:20Z","timestamp":1778085260230,"version":"3.51.4"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T00:00:00Z","timestamp":1686614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"Background<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>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.<\/jats:p><\/jats:sec>Methods<\/jats:title>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<\/mml:mi>=<\/mml:mo>79<\/mml:mn><\/mml:math><\/jats:inline-formula>) or a self-help text from the book \u201cDiabetes burnout\u201d as a control condition (n<\/mml:mi>=<\/mml:mo>77<\/mml:mn><\/mml:math><\/jats:inline-formula>). 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).<\/jats:p><\/jats:sec>Results<\/jats:title>Results indicate that people using the conversational agent have a larger reduction in diabetes distress (M<\/mml:mi>=<\/mml:mo>\u2212<\/mml:mo>0.305<\/mml:mn><\/mml:math><\/jats:inline-formula>, SD<\/mml:mi><\/mml:mrow>=<\/mml:mo>0.865<\/mml:mn><\/mml:math><\/jats:inline-formula>) than the control group (M<\/mml:mi>=<\/mml:mo>0.002<\/mml:mn><\/mml:math><\/jats:inline-formula>, SD<\/mml:mi><\/mml:mrow>=<\/mml:mo>0.743<\/mml:mn><\/mml:math><\/jats:inline-formula>) and this difference is statistically significant (t<\/mml:mi>(<\/mml:mo>154<\/mml:mn>)<\/mml:mo>=<\/mml:mo>2.377<\/mml:mn><\/mml:math><\/jats:inline-formula>, p<\/mml:mi>=<\/mml:mo>0.019<\/mml:mn><\/mml:math><\/jats:inline-formula>). A hypothesised mediation effect of \u201cattitude to the social help program\u201d was not observed.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>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.<\/jats:p><\/jats:sec>Ethics, Study Registration and Open Science<\/jats:title>This study has been preregistered with the Open Science Foundation (osf.io\/yb6vg) 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: https:\/\/surfdrive.surf.nl\/files\/index.php\/s\/4xSEHCrAu0HsJ4P<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2023.1149374","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T04:36:10Z","timestamp":1686630970000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Reducing social diabetes distress with a conversational agent support system: a three-week technology feasibility 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