Artificial Intelligence–Based Chatbots for Promoting Health Behavioral Changes: Systematic Review

Abstract

Background Artificial intelligence (AI)–based chatbots can offer personalized, engaging, and on-demand health promotion interventions. Objective The aim of this systematic review was to evaluate the feasibility, efficacy, and intervention characteristics of AI chatbots for promoting health behavior change. Methods A comprehensive search was conducted in 7 bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsycINFO, Web of Science, Embase, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated the feasibility or efficacy of AI chatbots for behavior change. The screening, extraction, and analysis of the identified articles were performed by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results Of the 15 included studies, several demonstrated the high efficacy of AI chatbots in promoting healthy lifestyles (n=6, 40%), smoking cessation (n=4, 27%), treatment or medication adherence (n=2, 13%), and reduction in substance misuse (n=1, 7%). However, there were mixed results regarding feasibility, acceptability, and usability. Selected behavior change theories and expert consultation were used to develop the behavior change strategies of AI chatbots, including goal setting, monitoring, real-time reinforcement or feedback, and on-demand support. Real-time user-chatbot interaction data, such as user preferences and behavioral performance, were collected on the chatbot platform to identify ways of providing personalized services. The AI chatbots demonstrated potential for scalability by deployment through accessible devices and platforms (eg, smartphones and Facebook Messenger). The participants also reported that AI chatbots offered a nonjudgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of the moderate to high risk of internal validity, insufficient description of AI techniques, and limitation for generalizability. Conclusions AI chatbots have demonstrated the efficacy of health behavior change interventions among large and diverse populations; however, future studies need to adopt robust randomized control trials to establish definitive conclusions.

Asynchronous Technologies in Mental Health Care and Education

“…Chatbots can be integrated into extensively used existing platforms like text SMS, Facebook Messenger, and WhatsApp. Chatbots make it feasible to access large and diverse populations; however, many studies currently are not representative of diverse geographies, cultures, and age groups thus hindering its generalizability [ 73 ].…”

“…Although deployment of these chatbots was through typically scalable platforms like Facebook Messenger, it found mixed results on feasibility, acceptability, and usability. Studies set in developing countries were limited in this review, which prompts the need to understand its ability to scale to these areas where platforms such as Facebook Messenger are frequently used [ 73 ].…”

Smartphone Apps for Cannabis Cessation: Quality Assessment and Content Analysis

“…However, more extensive randomized controlled trials are needed to draw definitive conclusions. 15 Based on the MARS analysis results, the applications scored the lowest on "information" quality, indicating a lack of evidence-based research within the applications. This is likely because clinicians were not involved in their production, and the focus was on creating engaging and functional experiences rather than information-heavy applications.…”

Chatbot-Delivered Online Intervention to Promote Seasonal Influenza Vaccination During the COVID-19 Pandemic

“…A recent systematic review demonstrated high efficacy of chatbots in promoting healthy lifestyles, smoking cessation, and treatment adherence and addressing issues related to substance misuse. 12 A few pilot studies have applied chatbots to provide information and answer questions about COVID-19 vaccines and have observed substantial increases in acceptance and intention to receive COVID-19 vaccines among users. [13][14][15] This RCT was conducted to evaluate the relative efficacy of a SOC-tailored online intervention (the intervention group) compared with a standard, non-SOC-tailored online intervention (the control group) in increasing SIV uptake among Hong Kong residents 65 years or older.…”

“…The chatbot is potentially useful to deliver SOC-tailored intervention promoting SIV. A recent systematic review demonstrated high efficacy of chatbots in promoting healthy lifestyles, smoking cessation, and treatment adherence and addressing issues related to substance misuse . A few pilot studies have applied chatbots to provide information and answer questions about COVID-19 vaccines and have observed substantial increases in acceptance and intention to receive COVID-19 vaccines among users …”