Evaluation of the Current State of Chatbots for Digital Health: Scoping Review

• Published in: Journal of medical Internet research 2023-12, Vol.25 (7), p.e47217-e47217
• Main Authors: Xue, Jia, Zhang, Bolun, Zhao, Yaxi, Zhang, Qiaoru, Zheng, Chengda, Jiang, Jielin, Li, Hanjia, Liu, Nian, Li, Ziqian, Fu, Weiying, Peng, Yingdong, Logan, Judith, Zhang, Jingwen, Xiang, Xiaoling
• Format: Article
• Language: English
• Subjects: Advertising campaigns; Algorithms; Analysis; Automation; Behavior; Behavior change; Benchmarking; Capacity building approach; Change agents; Chatbots; Checklist; Clinical trials; Communication; Computational linguistics; Customization; Design; Digital Health; Empathy; Health behavior; Health care; Health Promotion; Health status; Humans; Intervention; Language processing; Librarians; Mental health; Mental health promotion; Natural language interfaces; Pandemics; Physical activity; Privacy; Public health; Randomized Controlled Trials as Topic; Review; Social networks; Speech; Suicidal ideation; Suicide; Systematic review; Verbal communication; Well being
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/47217

Chatbots have become ubiquitous in our daily lives, enabling natural language conversations with users through various modes of communication. Chatbots have the potential to play a significant role in promoting health and well-being. As the number of studies and available products related to chatbots continues to rise, there is a critical need to assess product features to enhance the design of chatbots that effectively promote health and behavioral change. This scoping review aims to provide a comprehensive assessment of the current state of health-related chatbots, including the chatbots' characteristics and features, user backgrounds, communication models, relational building capacity, personalization, interaction, responses to suicidal thoughts, and users' in-app experiences during chatbot use. Through this analysis, we seek to identify gaps in the current research, guide future directions, and enhance the design of health-focused chatbots. Following the scoping review methodology by Arksey and O'Malley and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, this study used a two-pronged approach to identify relevant chatbots: (1) searching the iOS and Android App Stores and (2) reviewing scientific literature through a search strategy designed by a librarian. Overall, 36 chatbots were selected based on predefined criteria from both sources. These chatbots were systematically evaluated using a comprehensive framework developed for this study, including chatbot characteristics, user backgrounds, building relational capacity, personalization, interaction models, responses to critical situations, and user experiences. Ten coauthors were responsible for downloading and testing the chatbots, coding their features, and evaluating their performance in simulated conversations. The testing of all chatbot apps was limited to their free-to-use features. This review provides an overview of the diversity of health-related chatbots, encompassing categories such as mental health support, physical activity promotion, and behavior change interventions. Chatbots use text, animations, speech, images, and emojis for communication. The findings highlight variations in conversational capabilities, including empathy, humor, and personalization. Notably, concerns regarding safety, particularly in addressing suicidal thoughts, were evident. Approximately 44% (16/36) of the chatbots effectively a