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Technology-Assisted Motivational Interviewing and Referral Coach: The TAMI Coach

Institution: University of California, San Francisco
Investigator(s): Jason Satterfield,
Award Cycle: 2019 (Cycle 30) Grant #: T30IP0972 Award: $499,418
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: High Impact Pilot Award

Initial Award Abstract
Although rates of smoking have decreased dramatically, tobacco still accounts for 480,000 deaths per year and over 16 million adults suffer from smoking-related illnesses. This burden is disproportionately felt by underrepresented minorities and those in low income areas. Motivational interviewing (MI) is a strategy that has been used successfully to enhance patients’ motivation to quit smoking by exploring their mixed feelings about smoking or quitting. MI is a directive, yet non-judgmental, non-confrontational patient-centered approach that posits that patient speech expressing a commitment to change ("Change Talk") is associated with quitting smoking and speech opposing change ("Sustain Talk") is related to continued smoking. Although it works, MI can be time intensive, require substantial expertise, and patients will still need tailored referrals to smoking cessation programs that fit their needs and the local resources. Digital health interventions that assess readiness, deliver MI, and make tailored referrals to cessation treatment programs could potentially provide an effective and efficient way to help smokers quit thus preventing smoking-related illnesses and death. Using artificial intelligence and machine learning, this proposal creates a "smart" chatbot capable of delivering an MI-based intervention to assess and promote cessation readiness then elicit patient preferences for cessation interventions. The chatbot "personality" development will be based on effective(MI) therapist skills, and its ability to recognize client change talk indicative of smoking cessation change, will be derived from existing transcripts of MI interviews addressing smoking. The chatbot will then be further refined by using over 6,000 online interactions. This Technology Assisted Motivational Interviewing Coach, the "TAMI Coach", will interact with users until they are ready to quit smoking. Once a smoker is ready, the TAMI Coach will assist them in setting up an appointment with their PCP and/or assist in finding a local cessation program, quitline, or other effect digital tool like a website or texting program. Although focused on smoking cessation, the applications of the TAMI Coach could include helping patients get ready for other behavior changes like drinking, exercising, or eating healthier foods.