Background: One-size-fits-all counseling often underperforms in long-term cardiovascular prevention where sustained activation is required. We developed Signatures, a practical framework that maps individuals to four communication archetypes—Listener, Motivator, Director, with an Expert overlay—to guide message tone, structure, and shared decision-making at the point of care. The framework operationalizes psychographic segmentation into an implementable taxonomy. Methods: Classification uses three complementary pathways: (1) a 20-item self-assessment that summarizes activation and support-need domains; (2) a clinician 10-domain binary grid scored 0–10; and (3) a supervised NLP classifier that ingests de-identified narrative to estimate archetype probabilities. Discordance is resolved by conservative tie-breaking and barrier-domain overrides (health literacy, trust, access, food security). Intervention (Chatbot): We prototyped a rules-plus-NLP chatbot to (a) administer the self-assessment, (b) collect short narratives for NLP pre-labeling, and (c) deliver Signature-specific counseling (e.g., plain-language, one-step plans for Listeners; option sets and SMART weekly goals for Motivators; concise, data-driven progressions for Directors; synthesis and trade-offs for Experts). Example phrase templates were derived from our library of Signature-aligned responses for common health questions. Results: Formative testing established face validity of the three-pathway workflow and usability of chatbot dialogues. The system consistently generated actionable outputs: an assigned archetype, domain-level flags, and a message kit (tone, structure, and SDM cues) that clinicians can use or edit in real time. The chatbot supported weekly goal-setting, reminders, and teach-back prompts aligned to the assigned Signature. Conclusions: A triaged, multi-method classification combined with chatbot delivery is a feasible approach to precision communication in cardiovascular prevention, offering a practical bridge from psychographic theory to routine encounters and remote interactions. Prospective validation will assess concordance among pathways, equity, and effects on engagement, lifestyle habits, condition management and clinical proxies.
Dunn et al. (Tue,) studied this question.