Effectiveness of Chatbot for Improving Caregiving Outcomes in Primary Caregivers of Geriatric Pneumonia Patients: A Study on Knowledge, Attitude and Practice.

Overview

Pneumonia is a leading cause of death and hospitalization among the elderly in Taiwan. High-quality home care is essential to recovery and reducing readmission, yet primary caregivers often lack the specific skills needed, such as airway clearance and safe feeding techniques. Traditional education, consisting of one-time verbal instructions and paper brochures, often lacks interactivity and real-time support. This study introduces "Pneumonia Care Helper," an interactive LINE chatbot designed to provide digital health education. The goal is to evaluate whether this digital tool is more effective than traditional paper-based education in improving the knowledge, attitudes, and caregiving practices of primary caregivers of elderly pneumonia patients. The study will compare the outcomes of caregivers using the chatbot versus those receiving standard paper-based instructions over a 5-day intervention period.

Detailed description

This study employs a quasi-experimental research design to evaluate the effectiveness of a chatbot intervention, "Pneumonia Care Helper," in improving the caregiving capabilities of primary caregivers of elderly patients with pneumonia at Taipei Veterans General Hospital. Pneumonia remains a leading cause of mortality among the elderly in Taiwan, placing a significant burden on family caregivers who often lack professional medical training in essential tasks such as symptom recognition, airway clearance techniques, safe feeding practices, and oral hygiene. To address the limitations of traditional one-time verbal instructions and static paper-based materials, which often fail to provide interactive or real-time support, this research implements a digital health education framework via a mobile application. A total of 150 primary caregivers will be recruited from four specialized medical wards, including Hospital Medicine, Geriatrics, General Medicine, and Infectious Diseases. Participants are assigned to either the experimental or control group based on their respective hospital wards to minimize potential intervention crossover between participants in the same unit. Caregivers in the experimental group receive a five-day digital intervention featuring four specialized educational videos and an interactive, AI-driven chatbot for 24/7 on-demand inquiries. The control group receives a standardized 20-minute one-on-one verbal education session accompanied by a printed brochure containing identical content. The evaluation is guided by the Knowledge, Attitude, and Practice (KAP) theory, with assessments conducted at enrollment (Day 0) and upon completion of the five-day intervention (Day 5) using a validated KAP scale. This study aims to demonstrate the feasibility and efficacy of using mobile chatbot technology as a modern pedagogical tool to bridge the gap in clinical nursing education and enhance the overall quality of home-based pneumonia care for the elderly population.

Interventions

• Behavioral Chatbot with Educational Videos
  Participants will receive access to a dedicated chatbot named "Pneumonia Care Helper." The intervention lasts for 5 days. It includes: (1) Initial orientation on chatbot operation. (2) Unlimited on-demand access to four educational videos: Introduction to Pneumonia, Airway Clearance Techniques, Feeding and Tube Feeding Skills, and Oral Hygiene. (3) An interactive text-based AI response system for real-time Q\&A. Caregivers are encouraged to engage with the chatbot and watch the videos as many ti
• Behavioral Traditional Paper-based Education
  Participants will receive a 20-minute one-on-one verbal health education session conducted by the researcher upon enrollment. A printed pneumonia care brochure will be provided, containing information identical to the content in the chatbot's educational videos (Introduction to Pneumonia, Airway Clearance Techniques, Feeding and Tube Feeding Skills, and Oral Hygiene). The study period lasts for 5 days, during which caregivers have unlimited access to the brochure for review at any time.

Primary outcome measures

• Caregiver Knowledge of Elderly Pneumonia Care [Time frame: Baseline (Day 0) and 5 days after the initiation of the intervention.]
• Caregiver Attitude Toward Elderly Pneumonia Care [Time frame: Baseline (Day 0) and 5 days after the initiation of the intervention.]
• Caregiver Practice of Elderly Pneumonia Care [Time frame: Baseline (Day 0) and 5 days after the initiation of the intervention.]

Eligibility criteria

Inclusion criteria

• (1)Patients with a primary diagnosis of pneumonia during the current hospitalization.(2)Patients aged 65 years or older.(3)Primary caregivers aged 18 years or older.(4)Primary caregivers who can read and understand Mandarin Chinese.(5)Primary caregivers who own a mobile device (e.g., smartphone or tablet) and can use the chatbot application.

Exclusion criteria

• (1)Primary caregivers who do not live with the patient.(2)Primary caregivers who have received formal training as professional nursing assistants or caregivers.(3)Primary caregivers who are currently or were formerly healthcare professionals (e.g., physicians, nurses, therapists).(4)Primary caregivers who do not possess a mobile device or are unable to use chatbot applications.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

Taiwan · 1 center

• Taipei Veterans General Hospital — Taipei

Publications

• Cao Y, Liu C, Lin J, Ng L, Needleman I, Walsh T, Li C. Oral care measures for preventing nursing home-acquired pneumonia. Cochrane Database Syst Rev. 2022 Nov 16;11(11):CD012416. doi: 10.1002/14651858.CD012416.pub3. PMID 36383760
• Jenkins CL, Imran S, Mahmood A, Bradbury K, Murray E, Stevenson F, Hamilton FL. Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review. JMIR Res Protoc. 2022 Mar 18;11(3):e32538. doi: 10.2196/32538. PMID 35302946
• Ebihara T. Comprehensive Approaches to Aspiration Pneumonia and Dysphagia in the Elderly on the Disease Time-Axis. J Clin Med. 2022 Sep 10;11(18):5323. doi: 10.3390/jcm11185323. PMID 36142971
• Choonhawarakorn K, Kasemkhun P, Leelataweewud P. Effectiveness of a message service on child oral health practice via a social media application: A randomized controlled trial. Int J Paediatr Dent. 2025 Mar;35(2):446-455. doi: 10.1111/ipd.13256. Epub 2024 Aug 5. PMID 39104027
• Chen BL, Lien HC, Yang SS, Wu SC, Chiang HH, Lin LC. Impact of Mobile Apps in Conjunction With Percutaneous Endoscopic Gastrostomy on Patients' Complications, Quality of Life, and Health-Related Self-Care Behaviors: Randomized Clinical Trial. JMIR Mhealth Uhealth. 2023 Oct 20;11:e48970. doi: 10.2196/48970. PMID 37862072
• Button B, Goodell HP, Atieh E, Chen YC, Williams R, Shenoy S, Lackey E, Shenkute NT, Cai LH, Dennis RG, Boucher RC, Rubinstein M. Roles of mucus adhesion and cohesion in cough clearance. Proc Natl Acad Sci U S A. 2018 Dec 4;115(49):12501-12506. doi: 10.1073/pnas.1811787115. Epub 2018 Nov 12. PMID 30420506
• Belli S, Prince I, Savio G, Paracchini E, Cattaneo D, Bianchi M, Masocco F, Bellanti MT, Balbi B. Airway Clearance Techniques: The Right Choice for the Right Patient. Front Med (Lausanne). 2021 Feb 4;8:544826. doi: 10.3389/fmed.2021.544826. eCollection 2021. PMID 33634144
• Beach SR, Schulz R. Family Caregiver Factors Associated with Unmet Needs for Care of Older Adults. J Am Geriatr Soc. 2017 Mar;65(3):560-566. doi: 10.1111/jgs.14547. Epub 2016 Dec 9. PMID 27935019

Identifiers

NCT: NCT07463443 · 2025-12-005AC

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗