Promoting Relational Agent for Health Behavior Change in Low and Middle - Income Countries (LMICs): Issues and Approaches.

The use of contemporary technologies in healthcare systems to improve quality of care and to promote behavioral healthcare outcomes are prevalent in high-income countries. However, low and middle-income countries (LMICs) are not receiving the same advantages of technology, which may be due to inadequate technological infrastructure and financial resources, lack of interest among policy makers and healthcare service providers, lack of skills and capacity among healthcare professionals in using technology based interventions, and resistance of the public to the use of technologies for healthcare or health promotion activities. Technology-based interventions offer considerable promise to develop entirely new models of healthcare both within and outside of formal systems of care and offer the opportunity to have a large public health impact. Such technology-based interventions could be used to address targeted global health problems in LMICs, including the chronic non-communicable diseases (NCDs) - a growing health system burden in LMICs. Major preventable behavioral risk factors of chronic NCDs are increasing in LMICs, and innovative interventions are essential to address these risk factors. Computer-based or mobile-based virtual coaches or Relational Agents (RAs) are increasingly being explored for counseling patients to change their health behavior in high-income countries; however, the use of RAs in LMICs has not been studied. In this paper, we summarize the growing application of RA technology in behavior change interventions in high-income countries and describe the potential of its use in LMICs. Finally, we review the potential barriers and challenges in promoting RAs in LMICs.