Adherence and Engagement With a Cognitive Behavioral Therapy-Based Conversational Agent (Wysa for Chronic Pain) Among Adults With Chronic Pain: Survival Analysis

Abstract

Background: Digital applications are commonly used to support mental health and well-being. However, successfully retaining and engaging users to complete digital interventions is challenging, and comorbidities such as chronic pain further reduce user engagement. Digital conversational agents (CAs) may improve user engagement by applying engagement principles that have been implemented within in-person care settings.

Objective: To evaluate user retention and engagement with an artificial intelligence-led digital mental health app (Wysa for Chronic Pain) that is customized for individuals managing mental health symptoms and coexisting chronic pain.

Methods: In this ancillary survival analysis of a clinical trial, participants included 51 adults who presented to a tertiary care center for chronic musculoskeletal pain, who endorsed coexisting symptoms of depression or anxiety (Patient-Reported Outcomes Measurement Information System score of ≥55 for depression or anxiety), and initiated onboarding to an 8-week subscription of Wysa for Chronic Pain. The study outcomes were user retention, defined as revisiting the app each week and on the last day of engagement, and user engagement, defined by the number of sessions the user completed.

Results: Users engaged in a cumulative mean of 33.3 sessions during the 8-week study period. The survival analysis depicted a median user retention period (i.e., time to complete disengagement) of 51 days, with the usage of a morning check-in feature having a significant relationship with a longer retention period (P=.001).

Conclusions: Our findings suggest that user retention and engagement with a CBT-based CA built for users with chronic pain is higher than standard industry metrics. These results have clear implications for addressing issues of suboptimal engagement of digital health interventions and improving access to care for chronic pain. Future work should use these findings to inform the design of evidence-based interventions for individuals with chronic pain and to enhance user retention and engagement of digital health interventions more broadly.

Trial registration: ClinicalTrials.gov NCT04640090; https://ichgcp.net/clinical-trials-registry/NCT04640090.

Keywords: Wysa; app; chronic pain; conversational agent; digital application; digital health; digital intervention; engagement; health intervention; mental health; retention; symptom management; user engagement.

Conflict of interest statement

Conflicts of Interest: CS and MK are reported as being employees of Wysa Inc and owning equity in the company. ALC declares no conflicts of interest related to the study and is funded by the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR074520) and the Doris Duke Charitable Foundation. The pilot clinical trial was funded by a Washington University/BJC HealthCare Big Ideas innovation grant. Of note, the pilot clinical trial was conducted by ALC, and prespecified results were reported independent of input from Wysa Inc. This manuscript describes an ancillary analysis of data that were collected during the conduct of the pilot clinical trial.

©Chaitali Sinha, Abby L Cheng, Madhura Kadaba. Originally published in JMIR Formative Research (https://formative.jmir.org), 23.05.2022.

Figures

Figure 1

The conversational agent asks the user for a check-in time.

Figure 2

Kaplan-Meier survival curve modeling user retention in the Wysa for Chronic Pain app during the 8-week study period. Dashed lines represent 95% CIs of the survival curve. Model concordance=0.829 (SE 0.045, P=.001 on the Wald test).