essay / research

How cartoons might improve healthcare

Navigating tough conversations that affect mental health: apparently, there’s an app for that. Or actually, at least 15 apps.

Kognito just launched an app to help physicians discuss childhood weight gain with families, adding to their collection of simulation apps for healthcare sensitivity training. Called Change Talk, it’s the result of a two-year collaboration with the American Academy of Pediatrics. You can read more about it here, or download the app (I tried it myself, which I’ll get into later).

I’m not one to jump on the bandwagon of virtual problem-solving, but Kognito’s apps seem like they could make a difference. Their simulations attempt to train health care professionals to deal with a range of serious issues — from military families struggling with the effects of post-traumatic stress disorder, to diabetes patients hoping to avoid hospital readmission, to lending psychological support to Native American youths, who have the highest suicide rates in the U.S. There’s also, surprisingly, a program for training tobacco sellers to comply with the law.

But back to Change Talk — so far Kognito’s only free app. It uses principles from the therapeutic technique motivational interviewing. See a 2005 report on the effectiveness of motivational interviewing here.

First offered to treat substance abuse, motivational interviewing has been defined as a “client-centered counseling style” meant to help people address their mixed feelings toward their own behaviors. The goal is to get people to want to change, rather than force change upon them (though I imagine the line between those two goals occasionally gets thin). According to the 2005 report, this technique has been successfully used to treat alcohol abuse, drug addiction, weight and fitness problems, asthma, and diabetes, with more mixed results for cigarette use.

I have zero experience as a healthcare professional, but I wanted to try Change Talk myself. It takes the form of an animated role play. You can read about motivational interviewing before starting or go straight into a simulation. I chose the latter and ended up playing a doctor, speaking to Heather and her son, Ethan. I began by asking Heather if she’d be comfortable discussing Ethan’s weight — then, we were off.

Each round you get different options for what to say. Sometimes I could click a bubble above Ethan’s head to hear his thoughts. A few clicks and questions later, Ethan is explaining that the kids at school call him “Lard-o” to mock his size, Heather is getting upset over her son being bullied — and I feel surprisingly invested.

It’s weird to see human interaction measured in percentage points, and yes, the animations look like sophisticated Sims characters. But somehow, that didn’t distract from the fact that these kinds of conversations are needed in non-computerized life. To make sure I was doing OK, the head of another cartoon physician kept popping up to give me feedback. Asking Ethan how he thinks he can improve his health? A+, from the standard of motivational interviewing. Chiding Heather for keeping soda in the house and hence making her feel like a bad parent (an option I purposely chose to create conflict)? Not so good.

Some of this stuff sounds like common sense, and professionals should tailor conversations to the specific needs of the people they’re speaking to. But I’m guessing that when physicians sit down with parents, it’s not easy to say: “Your kid’s weight might be a problem, and you should make changes.” It felt real enough doing this with talking animations, and I experienced the value in getting advice on my words.

A few notes on the evidence supporting these apps: I found it interesting that the Kognito press release mentioned neuroscience. My search for studies on neuroscience and motivational interviewing yielding no published articles, just one PhD dissertation by a current professor. It reminded me of what I found looking into brain training. Brain training has constantly gotten slapped with a “neuroscience-approved” label — yet it draws mostly from good old-fashioned behavioral psychology.

Along with everyone else who frets over misapplications of neuroscience, I’ve wondered if such mislabeling reflects a belief that neuroscience sounds more impressive than psychology. Kognito may not share that belief. But this could be another example of companies throwing around the word “neuroscience” to give “psychology” help it doesn’t need.

Another note: it’s a bit hard to evaluate product efficacy based on reports published by the companies selling those same products. Kognito has posted research evaluations for all its programs, but those aren’t exactly from a disinterested source. And since they’re so brief, the reports invite questions — like the one assessing the simulation meant to help Native American students recognize psychological distress in their peers.

The simulation was judged successful because it made participants report that they became more comfortable approaching peers who seemed like they might be distressed. That sounds like a good sign that the program made students feel more equipped to deal with mental health issues. It’d be even better for follow-up studies to address how accurate and effective those self-reported interventions were.

Really, I hope these apps get as much follow-up as I did in my simulation, which ended with recaps from the doctor helping me, Heather, and my avatar. I don’t get to use this sentence often enough, but — there might be big potential in these cartoons.

 

 

 

 

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