The Development and Use of Chatbots in Public Health: Scoping Review

Abstract

Background Chatbots are computer programs that present a conversation-like interface through which people can access information and services. The COVID-19 pandemic has driven a substantial increase in the use of chatbots to support and complement traditional health care systems. However, despite the uptake in their use, evidence to support the development and deployment of chatbots in public health remains limited. Recent reviews have focused on the use of chatbots during the COVID-19 pandemic and the use of conversational agents in health care more generally. This paper complements this research and addresses a gap in the literature by assessing the breadth and scope of research evidence for the use of chatbots across the domain of public health. Objective This scoping review had 3 main objectives: (1) to identify the application domains in public health in which there is the most evidence for the development and use of chatbots; (2) to identify the types of chatbots that are being deployed in these domains; and (3) to ascertain the methods and methodologies by which chatbots are being evaluated in public health applications. This paper explored the implications for future research on the development and deployment of chatbots in public health in light of the analysis of the evidence for their use. Methods Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines for scoping reviews, relevant studies were identified through searches conducted in the MEDLINE, PubMed, Scopus, Cochrane Central Register of Controlled Trials, IEEE Xplore, ACM Digital Library, and Open Grey databases from mid-June to August 2021. Studies were included if they used or evaluated chatbots for the purpose of prevention or intervention and for which the evidence showed a demonstrable health impact. Results Of the 1506 studies identified, 32 were included in the review. The results show a substantial increase in the interest of chatbots in the past few years, shortly before the pandemic. Half (16/32, 50%) of the research evaluated chatbots applied to mental health or COVID-19. The studies suggest promise in the application of chatbots, especially to easily automated and repetitive tasks, but overall, the evidence for the efficacy of chatbots for prevention and intervention across all domains is limited at present. Conclusions More research is needed to fully understand the effectiveness of using chatbots in public health. Concerns with the clinical, legal, and ethical aspects of the use of chatbots for health care are well founded given the speed with which they have been adopted in practice. Future research on their use should address these concerns through the development of expertise and best practices specific to public health, including a greater focus on user experience.

Increasing Participation in a TelePrEP Program for Sexual and Gender Minority Adolescents and Young Adults in Louisiana: Protocol for an SMS Text Messaging–Based Chatbot

“…However, chatbots are relatively new to the public health arena. A 2022 scoping review assessing the research base for the use of chatbots in public health identified the need for more research describing the development process and evaluating the efficacy and effectiveness of these chatbots [ 25 ]. The breadth of information shared in both this paper and an upcoming paper evaluating the feasibility and acceptability of the PrEPBot will begin to address this gap in the literature.…”

Design, development and usability of an educational AI chatbot for People with Haemophilia in Senegal

“…14 However, their usability can be perceived as limited by the algorithms driving them, their scalability, or the lack of privacy perceived by their users. [13][14][15][16][17] To our knowledge, there is no chatbot currently that specifically meets the needs of PWH. We could not find a chatbot using any local languages of African countries in the literature.…”

“…Recent studies have demonstrated the rising development of chatbots in chronic diseases, e.g., for therapeutic education in diabetes 16 or sickle‐cell disease management 14 . However, their usability can be perceived as limited by the algorithms driving them, their scalability, or the lack of privacy perceived by their users 13–17 …”

Conversational AI facilitates mental health assessments and is associated with improved recovery rates

“…Previous research into the efficiencies and effectiveness of conversational AI solutions in healthcare is limited [Wilson et al, 2022]. The majority of studies investigating chatbots in a healthcare setting often only rely on brief follow-up periods [Vaidyam et al, 2019], trials in non-clinical settings [Fitzpatrick et al, 2017], or use differing definitions of “recovery” [Meadows et al, 2020].…”