Background Chatbots could be a scalable solution that provides an interactive means of engaging users in behavioral health interventions driven by artificial intelligence. Although some chatbots have shown promising early efficacy results, there is limited information about how people use these chatbots. Understanding the usage patterns of chatbots for depression represents a crucial step toward improving chatbot design and providing information about the strengths and limitations of the chatbots. Objective This study aims to understand how users engage and are redirected through a chatbot for depression (Tess) to provide design recommendations. Methods Interactions of 354 users with the Tess depression modules were analyzed to understand chatbot usage across and within modules. Descriptive statistics were used to analyze participant flow through each depression module, including characters per message, completion rate, and time spent per module. Slide plots were also used to analyze the flow across and within modules. Results Users sent a total of 6220 messages, with a total of 86,298 characters, and, on average, they engaged with Tess depression modules for 46 days. There was large heterogeneity in user engagement across different modules, which appeared to be affected by the length, complexity, content, and style of questions within the modules and the routing between modules. Conclusions Overall, participants engaged with Tess; however, there was a heterogeneous usage pattern because of varying module designs. Major implications for future chatbot design and evaluation are discussed in the paper.

Social isolation has affected people globally during the COVID-19 pandemic and had a major impact on older adult's well-being. Chatbot interventions may be a way to provide support to address loneliness and social isolation in older adults. The aims of the current study were to (1) understand the distribution of a chatbot's net promoter scores, (2) conduct a thematic analysis on qualitative elaborations to the net promoter scores, (3) understand the distribution of net promoter scores per theme, and (4) conduct a single word analysis to understand the frequency of words present in the qualitative feedback. A total of 7,099 adults and older adults consented to participate in a chatbot intervention on reducing social isolation and loneliness. The average net promoter score (NPS) was 8.67 out of 10. Qualitative feedback was provided by 766 (10.79%) participants which amounted to 898 total responses. Most themes were rated as positive (517), followed by neutral (311) and a minor portion as negative (70). The following five themes were found across the qualitative responses: positive outcome (277, 30.8%), user did not address question (262, 29.2%), bonding with the chatbot (240, 26.7%), negative technical aspects (70, 7.8%), and ambiguous outcome (49, 5.5%). Themes with a positive valence were found to be associated with a higher NPS. The word “help” and it's variations were found to be the most frequently used words, which is consistent with the thematic analysis. These results show that a chatbot for social isolation and loneliness was perceived positively by most participants. More specifically, users were likely to personify the chatbot (e.g., “Cause I feel like I have a new friend!”) and perceive positive personality features such as being non-judgmental, caring, and open to listen. A minor portion of the users reported dissatisfaction with chatting with a machine. Implications will be discussed.

Online parenting programs are an effective way to teach behavioral management skills to parents in the absence of in‐person resources. This community‐engaged study aimed to examine strategies for disseminating online parenting resources in schools. Online resources were disseminated to parents in a Northern California school district. Dissemination strategies were informed by conversations with school principals, teachers, and parents and considered agent, message, and format. A total of 685 parents and teachers clicked on the online resources: 151 parents and 114 teachers attended synchronous classes. The use of dissemination strategies had a compounding influence on the number of synchronous class attendees and clicks. Emails sent by the school district yielded the greatest number of clicks, which was influenced by message content and format. A community–academic partnership (CAP) led to the dissemination of evidence‐based online parenting resources to a large population and led to lessons learned that could inform future research involving CAPs.

Background: Chatbots are a relatively new technology that has shown promising outcomes for mental health symptoms in adults; however, few studies have been done with adolescents or reported adolescent user experiences and recommendations for chatbot development. Methods: Twenty three participants ages 13-18 (M age = 14.96) engaged in user testing of a chatbot developed to psychoeducate adolescents on depression, teach behavioral activation, and change negative thoughts. Thematic analysis was conducted of participants' responses to user experience questions, impressions, and recommendations. Results: Over half (56.5%) of the sample completed the full intervention and provided user experience feedback online. The average NPS score was 6.04 (SD = 2.18), and 64.3% (n = 9) said they would use the chatbot in the future. Of all user experience responses, 54.5% were positive. The most common impressions were related to symptom improvement (61.1%) and availability (52.8%) The most frequent recommendations were related to solving technical problems (66%). Conclusions: Chatbots for mental health are acceptable to some adolescents, a population that tends to be reluctant to engage with traditional mental health services. Most participants reported positive experiences with the chatbot, believing that it could help with symptom improvement and is highly available. Adolescents highlighted some technical and stylistic problems that developers should consider. More pilot and user testing is needed to develop mental health chatbots that are appealing and relevant to adolescents. Key practitioner message• Chatbots are a relatively new technology; however, few studies have been done with adolescents.• Most adolescents perceived the chatbot positively and believed that it could help with symptom improvement and that it is highly available. • Chatbots for mental health are acceptable to some adolescents, a population that tends to be reluctant to engage with traditional mental health services.

Background: The Patient Health Questionnaire-9 (PHQ-9) is a brief depression measure that has been validated. A chatbot version of the PHQ-9 would allow the assessment of depressive symptoms remotely, at a large scale and low cost.Objective: The current study aims to: Assess the feasibility of administering the PHQ-9 in a sample of adults and older adults via chatbot, report the psychometric properties of and identify the relationship between demographic variables and PHQ-9 total scores.Methods: A sample of 3,902 adults and older adults in the US and Canada were recruited through Facebook from August 2019 to February 2020 to complete the PHQ-9 using a chatbot.Results: A total of 3,895 (99.82%) completed the PHQ-9 successfully. The internal consistency of the PHQ-9 was 0.896 (p < 0.05). A one factor structure was found to have good model fit [X2 (27, N = 1,948) = 365.396, p < 0.001; RMSEA = 0.080 (90% CI: 0.073, 0.088); CFI and TLI were 0.925 and 0.900, respectively, and SRMR was 0.039]. All of the demographic characteristics in this study were found to significantly predict PHQ-9 total score, however; their effect was negligible to weak.Conclusions: There was a large sample of adults and older adults were open to completing assessments via chatbot including those over 75. The psychometric properties of the chatbot version of the PHQ-9 provide initial support to the utilization of this assessment method.

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BackgroundThe use of chatbots to address mental health conditions have become increasingly popular in recent years. However, few studies aimed to teach parenting skills through chatbots, and there are no reports on parental user experience. Aim: This study aimed to assess the user experience of a parenting chatbot micro intervention to teach how to praise children in a Spanish-speaking country.MethodsA sample of 89 parents were assigned to the chatbot micro intervention as part of a randomized controlled trial study. Completion rates, engagement, satisfaction, net promoter score, and acceptability were analyzed.Results66.3% of the participants completed the intervention. Participants exchanged an average of 49.8 messages (SD = 1.53), provided an average satisfaction score of 4.19 (SD = .79), and reported that they would recommend the chatbot to other parents (net promoter score = 4.63/5; SD = .66). Acceptability level was high (ease of use = 4.66 [SD = .73]; comfortability = 4.76 [SD = .46]; lack of technical problems = 4.69 [SD = .59]; interactivity = 4.51 [SD = .77]; usefulness for everyday life = 4.75 [SD = .54]).ConclusionsOverall, users completed the intervention at a high rate, engaged with the chatbot, were satisfied, would recommend it to others, and reported a high level of acceptability. Chatbots have the potential to teach parenting skills however research on the efficacy of parenting chatbot interventions is needed.

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