A Multilingual Digital Mental Health and Well-Being Chatbot (ChatPal): Pre-Post Multicenter Intervention Study

Abstract

Background In recent years, advances in technology have led to an influx of mental health apps, in particular the development of mental health and well-being chatbots, which have already shown promise in terms of their efficacy, availability, and accessibility. The ChatPal chatbot was developed to promote positive mental well-being among citizens living in rural areas. ChatPal is a multilingual chatbot, available in English, Scottish Gaelic, Swedish, and Finnish, containing psychoeducational content and exercises such as mindfulness and breathing, mood logging, gratitude, and thought diaries. Objective The primary objective of this study is to evaluate a multilingual mental health and well-being chatbot (ChatPal) to establish if it has an effect on mental well-being. Secondary objectives include investigating the characteristics of individuals that showed improvements in well-being along with those with worsening well-being and applying thematic analysis to user feedback. Methods A pre-post intervention study was conducted where participants were recruited to use the intervention (ChatPal) for a 12-week period. Recruitment took place across 5 regions: Northern Ireland, Scotland, the Republic of Ireland, Sweden, and Finland. Outcome measures included the Short Warwick-Edinburgh Mental Well-Being Scale, the World Health Organization-Five Well-Being Index, and the Satisfaction with Life Scale, which were evaluated at baseline, midpoint, and end point. Written feedback was collected from participants and subjected to qualitative analysis to identify themes. Results A total of 348 people were recruited to the study (n=254, 73% female; n=94, 27% male) aged between 18 and 73 (mean 30) years. The well-being scores of participants improved from baseline to midpoint and from baseline to end point; however, improvement in scores was not statistically significant on the Short Warwick-Edinburgh Mental Well-Being Scale (P=.42), the World Health Organization-Five Well-Being Index (P=.52), or the Satisfaction With Life Scale (P=.81). Individuals that had improved well-being scores (n=16) interacted more with the chatbot and were significantly younger compared to those whose well-being declined over the study (P=.03). Three themes were identified from user feedback, including “positive experiences,” “mixed or neutral experiences,” and “negative experiences.” Positive experiences included enjoying exercises provided by the chatbot, while most of the mixed, neutral, or negative experiences mentioned liking the chatbot overall, but there were some barriers, such as technical or performance errors, that needed to be overcome. Conclusions Marginal improvements in mental well-being were seen in those who used ChatPal, albeit nonsignificant. We propose that the chatbot could be used along with other service offerings to complement different digital or face-to-face services, although further research should be carried out to confirm the effectiveness of this approach. Nonetheless, this paper highlights the need for blended service offerings in mental health care.

A Mental Health and Well-Being Chatbot: User Event Log Analysis

“…The majority of users (348/579, 60%) of the ChatPal chatbot app were recruited as volunteers in a 12-week prepost study [25]. User interactions occurred at all hours of the day, with the majority being during working hours.…”

“…There were a total of 1403 individual users that accessed the app between January 24, 2022, and June 22, 2022. Only data from users older than 18 years were included in the analysis; thus, the results report on data from 579 adult users, of whom 348 (60.1%) were recruited specifically for a 12-week prepost study [25]. The majority of users identified as female (387/579, 66.8%), male (153/579, 26.4%), or other (6/579, 1%), while other users preferred not to say (12/579, 2.1%) or elected not to answer (21/579, 3.6%).…”

A Self-Guided Web-Based App (MyDiaMate) for Enhancing Mental Health in Adults With Type 1 Diabetes: Insights From a Real-World Study in the Netherlands

“…Whereas self-selection is intrinsic to a fully self-guided app, the experienced lack of human contact may at least partly be resolved by adding a conversational user interface, that is, a chatbot. While not preferred by all, and issues around psychological distance and trust exist, studies on chatbots in digital mental health applications show promising results [ 28 - 30 ]. Also, adding optional online peer support groups may be helpful in this respect, and deserves to be further explored.…”

A Self-Guided Web-Based App (MyDiaMate) for Enhancing Mental Health in Adults With Type 1 Diabetes: Insights From a Real-World Study in the Netherlands (Preprint)

“…Whereas self-selection is intrinsic to a fully self-guided app, the experienced lack of human contact may at least partly be resolved by adding a conversational user interface, that is, a chatbot. While not preferred by all, and issues around psychological distance and trust exist, studies on chatbots in digital mental health applications show promising results [28][29][30]. Also, adding…”