eHealth lifestyle interventions without human support (self-help interventions) are generally less effective, as they suffer from lower adherence levels. To solve this, we investigated whether (1) using a text-based conversational agent (TCA) and applying human cues contribute to a working alliance with the TCA, and whether (2) adding human cues and establishing a positive working alliance increase intervention adherence. Participants ( = 121) followed a TCA-supported app-based physical activity intervention. We manipulated two types of human cues: visual (ie, message appearance) and relational (ie, message content). We employed a 2 (visual cues: yes, no) x 2 (relational cues: yes, no) between-subjects design, resulting in four experimental groups: (1) visual and relational cues, (2) visual cues only, (3) relational cues only, or (4) no human cues. We measured the working alliance with the Working Alliance Inventory Short Revised form and intervention adherence as the number of days participants responded to the TCA's messages. Contrary to expectations, the working alliance was unaffected by using human cues. Working alliance was positively related to adherence ((78) = 3.606, = .001). Furthermore, groups who received visual cues showed lower adherence levels compared to those who received relational cues only or no cues ( = 1140.5, = −3.520, < .001). We replicated the finding that establishing a working alliance contributes to intervention adherence, independently of the use of human cues in a TCA. However, we were unable to show that adding human cues impacted the working alliance and increased adherence. The results indicate that adding visual cues to a TCA may even negatively affect adherence, possibly because it may create confusion concerning the true nature of the coach, which may prompt unrealistic expectations.

中文翻译：

---

电子健康中的人类线索促进生活方式的改变：一项检验自助干预依从性的实验现场研究

没有人类支持的电子健康生活方式干预措施（自助干预措施）通常效果较差，因为它们的依从性较低。为了解决这个问题，我们调查了 (1) 使用基于文本的对话代理 (TCA) 并应用人类线索是否有助于与 TCA 建立工作联盟，以及 (2) 添加人类线索并建立积极的工作联盟是否可以提高干预依从性。参与者 (= 121) 遵循 TCA 支持的基于应用程序的身体活动干预措施。我们操纵两种类型的人类线索：视觉（即消息外观）和关系（即消息内容）。我们采用 2（视觉线索：是、否）x 2（关系线索：是、否）受试者间设计，产生四个实验组：(1) 视觉和关系线索，(2) 仅视觉线索，(3 ) 仅关系线索，或 (4) 没有人类线索。我们使用工作联盟清单简短修订表来衡量工作联盟的情况，并根据参与者响应 TCA 消息的天数来衡量干预措施的遵守情况。与预期相反，工作联盟并未受到人类暗示的影响。工作联盟与依从性呈正相关 ((78) = 3.606, = .001)。此外，与仅接受关系提示或不接受提示的组相比，接受视觉提示的组表现出较低的依从性 (= 1140.5, = -3.520, < .001)。我们重复了这一发现，即建立工作联盟有助于坚持干预，独立于 TCA 中人类线索的使用。然而，我们无法证明添加人类线索会影响工作联盟并提高依从性。结果表明，在 TCA 中添加视觉提示甚至可能会对依从性产生负面影响，可能是因为它可能会造成对教练真实本质的混淆，从而导致不切实际的期望。