Artificial Intelligence (AI)-based Chatbots in Promoting Health Behavioral Changes: A Systematic Review

Abstract

Background Artificial-Intelligence (AI)-based chatbots can offer personalized, engaging, and on-demand health-promotion interventions. This systematic review evaluates the feasibility, efficacy, and intervention characteristics of AI-chatbots in promoting health-behavior change. Methods A comprehensive search was conducted in seven bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsychoINFO, Web of Science, EMBASE, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated feasibility and/or efficacy of AI-chatbots for behavioral change. The screening, extraction, and analyses of identified articles followed the PRISMA guidelines. Results Of the 15 included studies, majority studies (n=11) reported high usability, acceptability and engagement, and some evidence on feasibility of AI-chatbots. Selected studies demonstrated high efficacy in promoting healthy lifestyles (n=6), smoking cessation (n=4), treatment/medication adherence (n=2), and reduction in substance misuse (n=1). Behavioral change theories and/or expert consultation were used to develop behavioral change strategies of AI-chatbots, including goal setting, monitoring, real-time reinforcement/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 (e.g., smartphones and messenger). Participants also reported that AI-chatbots offered a non-judgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of moderate to high risk of internal validity, insufficient description of AI-techniques, and limitation for generalizability. Conclusion AI-chatbots have demonstrated efficacy of health-behavior change interventions among large and diverse population; however, future studies need to adopt robust RCTs to establish definitive conclusions.

Experiences of Freelancers with AI and Chatbots

“…In healthcare, the use of AI chatbots to promote health behavioral changes (Aggarwal et al, 2022;Mahdavi et al, 2023) mirrors our observations of AI chatbots facilitating behavioral adjustments in work routines among freelancers. This similarity emphasizes AI's capability to influence behavior across contexts, from health to work habits, showcasing its adaptability and impact on human actions.…”

“…I chatbots have found applications in a wide array of settings, ranging from educational institutions and retail to the healthcare industry, each domain leveraging these technologies to enhance operational efficiency and user engagement (Aggarwal et al, 2022;Cain, 2023;Lee, 2022). In the educational sector, the incorporation of AI chatbots has sparked a vital discourse on their potential to assist in academic pursuits such as writing and article review (Lee, 2023;van Dis et al, 2023).…”

“…In healthcare, AI chatbots have been deployed to facilitate health behavior changes and offer support during global health emergencies, such as the COVID-19 pandemic (Aggarwal et al, 2022;Mahdavi et al, 2023). These initiatives underscore the versatility of AI chatbots in promoting health-conscious behaviors and providing essential services during times of crisis.…”

Patient Acceptability of Symptom Screening and Patient Education Using a Chatbot for Autoimmune Inflammatory Diseases: Survey Study

“…A pilot study was conducted from June to October 2022, with a predetermined sample size of 200 participants, which included 100 new cases and 100 FU cases. The sample size was determined based on previous studies [ 34 , 35 ]. Upon registration in the rheumatology outpatient clinic, a random sample of patients aged ≥17 years with a diagnosis of AIIRD or a referral for suspected AIIRD was selected.…”