Gaining Control of One's Health: The Role of AI in Health Literacy

Abstract

Designing for health literacy requires understanding both how people make sense of health information and how technology can meaningfully support this sense-making process.Every day life is filled with decisions about one's health.Sometimes these are small, low-risk choices, such as selecting a healthy meal, while at other times they involve more impactful decisions, such as selfmanaging a chronic condition.Yet what drives people to take action or refrains them from doing so?A key factor for answering this lies within the concept of health literacy.Health literacy refers to the level of confidence, knowledge, and personal skills required to take action to access, understand, and use information to promote health.The challenging yet ultimate goal of health literacy is to encourage greater independence and empowerment among individuals.In this PhD thesis, I have investigated how AI can support individuals' health literacy, as a step towards achieving health autonomy.This thesis employs both qualitative and quantitative methods, including contextual inquiries and controlled experiments, to explore the factors that influence people's independent health-related decision-making.In doing so, I employ subjective belief items, such as Self-efficacy and Health Locus of Control, to explore how people's confidence and perceived control over their health motivate them to act on their health decisions.Complementing this psychological perspective, Signalling Theory provides a lens for understanding how AI can communicate trustworthiness through cues and how such signals can shape these beliefs and influence behaviour.The overall contribution of this thesis is grounded in four research papers.Paper 1 investigates how AI systems can provide adaptive, explanatory guidance to strengthen knowledge and autonomy during clinical training.Paper 2 examines how cues of ability, benevolence, and integrity influence individuals' trust in AI-provided information.Paper 3 explores how persuasive AI behaviours influence individuals' confidence in their own ability to manage their health.Paper 4 investigates how people navigate conflicting and aligning recommendations from human and AI sources, and how perceived health control and confidence shape their health-related decisions.The insights from these four papers identify how people's confidence, knowledge, and skills can lead to more independent action-taking behaviours for accessing, understanding, and applying information to promote health management.Specifically, I found that affirming verbal persuasions in AI behaviour can enhance people's Self-efficacy, strengthening their belief in their ability to perform health-related tasks.To support this process, AI guidance should be most proactive at the beginning of an interaction, helping users build understanding and confidence, before gradually subsiding as independence and knowledge increase.Additionally, trust cues should be carefully calibrated to users' perceived vulnerability and sense of control, ensuring that guidance supports trust without encouraging over-reliance.Finally, AI guidance should be tailored to users' Selfefficacy and Health Locus of Control, as these shape people's subjective beliefs about their active and collaborative role in their decision-making processes for maintaining health-related behaviours.i not be without either.The one who has helped me navigate this process, provided feedback, and encouragement along the way is my supervisor, Niels van Berkel.Thank you, Niels, for the hard work and long hours you have put into your supervision.I am sure it has not always been easy, with me working late nights, days before deadlines or showing up to meetings without a finished draft.Yet, you always pulled through, answered every text, but most of all, you cared.For that, I am truly grateful.Without this PhD, I would never have met some of the most incredible people.I would never have met Shagen or had those completely inappropriate workplace conversations in his office.And Sam, for coming into my office, dancing to Justin Timberlake and singing along to Anuc.David, for the long walks with Svend, talking about everything and nothing.And Maria, the most talented person I have ever met, who can create masterpieces with nothing but a pencil and a piece of paper.Joel and Sander, for being there from the very beginning, sharing our wins and failures, and laughing about plots that could easily be misinterpreted.It was not always work that got me out of bed in the morning, but the thought of spending time with all of you.As someone said not long ago, "This is more than work; otherwise, we wouldn't be here."Thank you for making me laugh, being my friends, and for making the days a little less hard.To everyone in HCC, thank you for all the fun memories, from retreats to social events.I appreciate all of you.Also, thank you, Susanne, for always having an open door and patiently helping me with all my travel reimbursement questions.Thank you, Jorge Goncalves, for so gracefully hosting me at the University of Melbourne.I look back on those four months with gratitude and appreciation for the memories, inspiring research, and the wonderful people I met, especially Saumya, Samangi, Sarah and Jarod.The work in this thesis is dedicated to my family.Without them, I would never in a million years have reached this point.To my mom, thank you for your endless love and support.No matter how far I travelled for work, I always knew I would come home to a basket of food and drinks waiting outside the door.To my dad, thank you for your love and for travelling to the other side of the world to spend Christmas with me during my stay abroad.To my sisters, Cecilie and Helene, thank you for being my greatest inspiration and joy in life.To Alex, for listening to every presentation I have ever practised, for restarting the timer, and for laughing with me whenever I mispronounced a word.Thank you for speaking proudly of my work, even in my absence, and for always being the one in the audience with the biggest smile.I love you, and I feel

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