A collaborative approach to the evaluation of cognitive accessibility of a conversational agent for public healthcare

Abstract Conversational agents are increasingly being introduced in healthcare to enhance access to healthcare and address limited healthcare resources. The aim of this study was to explore experiences of a conversational agent for symptom checking and triage tool assessing the urgency and appropriate level of care implemented in public healthcare from a cognitive accessibility perspective. With a Participatory Action Research approach, this study includes: (1) A Participatory Cognitive Barrier Walkthrough in workshops with people with cognitive impairment (n = 7), product owner representatives (n = 4), and researchers (n = 5), followed by a workshop for improvement suggestions; (2) a paired interview with healthcare system specialists (n = 2). The data from the study were analyzed using reflexive thematic analysis, resulting in five themes: ‘The design of the eHealth service created expectations that were not met during interaction’; ‘The eHealth service uses a difficult language’; ‘The eHealth service triggers negative emotions and reactions’; ‘The layout and graphic design of the eHealth service is difficult and sometimes misleading’; and ‘The eHealth service lacks in trustworthiness’. The findings show the importance of including people with lived experience of cognitive impairment, to expose and find solutions for cognitive accessibility issues.