Using the Pan American Health Organization Digital Conversational Agent to Educate the Public on Alcohol Use and Health: Preliminary Analysis

Abstract

Background There is widespread misinformation about the effects of alcohol consumption on health, which was amplified during the COVID-19 pandemic through social media and internet channels. Chatbots and conversational agents became an important piece of the World Health Organization (WHO) response during the COVID-19 pandemic to quickly disseminate evidence-based information related to COVID-19 and tobacco to the public. The Pan American Health Organization (PAHO) seized the opportunity to develop a conversational agent to talk about alcohol-related topics and therefore complement traditional forms of health education that have been promoted in the past. Objective This study aimed to develop and deploy a digital conversational agent to interact with an unlimited number of users anonymously, 24 hours a day, about alcohol topics, including ways to reduce risks from drinking, that is accessible in several languages, at no cost, and through various devices. Methods The content development was based on the latest scientific evidence on the impacts of alcohol on health, social norms about drinking, and data from the WHO and PAHO. The agent itself was developed through a nonexclusive license agreement with a private company (Soul Machines) and included Google Digital Flow ES as the natural language processing software and Amazon Web Services for cloud services. Another company was contracted to program all the conversations, following the technical advice of PAHO staff. Results The conversational agent was named Pahola, and it was deployed on November 19, 2021, through the PAHO website after a launch event with high publicity. No identifiable data were used and all interactions were anonymous, and therefore, this was not considered research with human subjects. Pahola speaks in English, Spanish, and Portuguese and interacts anonymously with a potentially infinite number of users through various digital devices. Users were required to accept the terms and conditions to enable access to their camera and microphone to interact with Pahola. Pahola attracted good attention from the media and reached 1.6 million people, leading to 236,000 clicks on its landing page, mostly through mobile devices. Only 1532 users had a conversation after clicking to talk to Pahola. The average time users spent talking to Pahola was 5 minutes. Major dropouts were observed in different steps of the conversation flow. Some questions asked by users were not anticipated during programming and could not be answered. Conclusions Our findings showed several limitations to using a conversational agent for alcohol education to the general public. Improvements are needed to expand the content to make it more meaningful and engaging to the public. The potential of chatbots to educate the public on alcohol-related topics seems enormous but requires a long-term investment of resources and research to be useful and reach many more people.

The future landscape of large language models in medicine

“…Examples of such tools are First Derm 36 , 37 , a teledermoscopy application for the diagnosis of skin conditions, enabling dermatologists to remotely assess and provide guidance, and Pahola 38 , a digital chatbot to provide guidance on alcohol consumption. Currently, the success of such digital health applications is mostly limited by technical constraints 39 and limited acceptance by healthcare practitioners 40 . The rapid advancement of LLMs and subsequent improvements in functionality and usability could help overcome these limitations.…”

Chatbots and COVID-19: Taking Stock of the Lessons Learned

“…As a result, there was a tremendous surge of interest in digital technology, including chatbots-computer programs that present a conversation-like interface through which people can access information and services [2]. During the early stages of the COVID-19 pandemic, national and subnational governments, as well as international health organizations such as the World Health Organization (WHO) [3,4] and the United States Centers for Disease Control and Prevention (CDC) [5], private companies, nongovernmental organizations, and researchers explored these new channels to reach people who were otherwise cut off from health services.…”

“…Nonetheless, chatbots can also be a valuable tool for increasing access by overcoming literacy barriers for some populations and some globally focused chatbots have already been developed in multiple languages. Pahola (a chatbot designed to help people reduce their alcohol consumption [3]) and Florence (a chatbot designed to help people with multitude of health concerns, including smoking cessation [4]), for example, "speak" 4 and 7 different languages, respectively.…”