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Laymouna M, Ma Y, Lessard D, Schuster T, Engler K, Lebouché B. Roles, Users, Benefits, and Limitations of Chatbots in Health Care: Rapid Review. J Med Internet Res 2024; 26:e56930. [PMID: 39042446 DOI: 10.2196/56930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Chatbots, or conversational agents, have emerged as significant tools in health care, driven by advancements in artificial intelligence and digital technology. These programs are designed to simulate human conversations, addressing various health care needs. However, no comprehensive synthesis of health care chatbots' roles, users, benefits, and limitations is available to inform future research and application in the field. OBJECTIVE This review aims to describe health care chatbots' characteristics, focusing on their diverse roles in the health care pathway, user groups, benefits, and limitations. METHODS A rapid review of published literature from 2017 to 2023 was performed with a search strategy developed in collaboration with a health sciences librarian and implemented in the MEDLINE and Embase databases. Primary research studies reporting on chatbot roles or benefits in health care were included. Two reviewers dual-screened the search results. Extracted data on chatbot roles, users, benefits, and limitations were subjected to content analysis. RESULTS The review categorized chatbot roles into 2 themes: delivery of remote health services, including patient support, care management, education, skills building, and health behavior promotion, and provision of administrative assistance to health care providers. User groups spanned across patients with chronic conditions as well as patients with cancer; individuals focused on lifestyle improvements; and various demographic groups such as women, families, and older adults. Professionals and students in health care also emerged as significant users, alongside groups seeking mental health support, behavioral change, and educational enhancement. The benefits of health care chatbots were also classified into 2 themes: improvement of health care quality and efficiency and cost-effectiveness in health care delivery. The identified limitations encompassed ethical challenges, medicolegal and safety concerns, technical difficulties, user experience issues, and societal and economic impacts. CONCLUSIONS Health care chatbots offer a wide spectrum of applications, potentially impacting various aspects of health care. While they are promising tools for improving health care efficiency and quality, their integration into the health care system must be approached with consideration of their limitations to ensure optimal, safe, and equitable use.
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Affiliation(s)
- Moustafa Laymouna
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Yuanchao Ma
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Tibor Schuster
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Sezgin E, Kocaballi AB, Dolce M, Skeens M, Militello L, Huang Y, Stevens J, Kemper AR. Chatbot for Social Need Screening and Resource Sharing With Vulnerable Families: Iterative Design and Evaluation Study. JMIR Hum Factors 2024; 11:e57114. [PMID: 39028995 PMCID: PMC11297373 DOI: 10.2196/57114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Health outcomes are significantly influenced by unmet social needs. Although screening for social needs has become common in health care settings, there is often poor linkage to resources after needs are identified. The structural barriers (eg, staffing, time, and space) to helping address social needs could be overcome by a technology-based solution. OBJECTIVE This study aims to present the design and evaluation of a chatbot, DAPHNE (Dialog-Based Assistant Platform for Healthcare and Needs Ecosystem), which screens for social needs and links patients and families to resources. METHODS This research used a three-stage study approach: (1) an end-user survey to understand unmet needs and perception toward chatbots, (2) iterative design with interdisciplinary stakeholder groups, and (3) a feasibility and usability assessment. In study 1, a web-based survey was conducted with low-income US resident households (n=201). Following that, in study 2, web-based sessions were held with an interdisciplinary group of stakeholders (n=10) using thematic and content analysis to inform the chatbot's design and development. Finally, in study 3, the assessment on feasibility and usability was completed via a mix of a web-based survey and focus group interviews following scenario-based usability testing with community health workers (family advocates; n=4) and social workers (n=9). We reported descriptive statistics and chi-square test results for the household survey. Content analysis and thematic analysis were used to analyze qualitative data. Usability score was descriptively reported. RESULTS Among the survey participants, employed and younger individuals reported a higher likelihood of using a chatbot to address social needs, in contrast to the oldest age group. Regarding designing the chatbot, the stakeholders emphasized the importance of provider-technology collaboration, inclusive conversational design, and user education. The participants found that the chatbot's capabilities met expectations and that the chatbot was easy to use (System Usability Scale score=72/100). However, there were common concerns about the accuracy of suggested resources, electronic health record integration, and trust with a chatbot. CONCLUSIONS Chatbots can provide personalized feedback for families to identify and meet social needs. Our study highlights the importance of user-centered iterative design and development of chatbots for social needs. Future research should examine the efficacy, cost-effectiveness, and scalability of chatbot interventions to address social needs.
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Affiliation(s)
- Emre Sezgin
- Nationwide Children's Hospital, Columbus, OH, United States
| | - A Baki Kocaballi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Millie Dolce
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Micah Skeens
- Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Yungui Huang
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Jack Stevens
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Alex R Kemper
- Nationwide Children's Hospital, Columbus, OH, United States
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3
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Moons P. For better or for worse: when chatbots influence human emotions and behaviours. Eur J Cardiovasc Nurs 2024; 23:e49-e51. [PMID: 37791604 DOI: 10.1093/eurjcn/zvad098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 35 PB7001, 3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, 7700 Cape Town, South Africa
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4
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Singh B, Ahmed M, Staiano AE, Gough C, Petersen J, Vandelanotte C, Kracht C, Huong C, Yin Z, Vasiloglou MF, Pan CC, Short CE, Mclaughlin M, von Klinggraeff L, Pfledderer CD, Moran LJ, Button AM, Maher CA. A systematic umbrella review and meta-meta-analysis of eHealth and mHealth interventions for improving lifestyle behaviours. NPJ Digit Med 2024; 7:179. [PMID: 38969775 PMCID: PMC11226451 DOI: 10.1038/s41746-024-01172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
The aim of this meta-meta-analysis was to systematically review randomised controlled trial (RCT) evidence examining the effectiveness of e- and m-Health interventions designed to improve physical activity, sedentary behaviour, healthy eating and sleep. Nine electronic databases were searched for eligible studies published from inception to 1 June 2023. Systematic reviews with meta-analyses of RCTs that evaluate e- and m-Health interventions designed to improve physical activity, sedentary behaviour, sleep and healthy eating in any adult population were included. Forty-seven meta-analyses were included, comprising of 507 RCTs and 206,873 participants. Interventions involved mobile apps, web-based and SMS interventions, with 14 focused on physical activity, 3 for diet, 4 for sleep and 26 evaluating multiple behaviours. Meta-meta-analyses showed that e- and m-Health interventions resulted in improvements in steps/day (mean difference, MD = 1329 [95% CI = 593.9, 2065.7] steps/day), moderate-to-vigorous physical activity (MD = 55.1 [95% CI = 13.8, 96.4] min/week), total physical activity (MD = 44.8 [95% CI = 21.6, 67.9] min/week), sedentary behaviour (MD = -426.3 [95% CI = -850.2, -2.3] min/week), fruit and vegetable consumption (MD = 0.57 [95% CI = 0.11, 1.02] servings/day), energy intake (MD = -102.9 kcals/day), saturated fat consumption (MD = -5.5 grams/day), and bodyweight (MD = -1.89 [95% CI = -2.42, -1.36] kg). Analyses based on standardised mean differences (SMD) showed improvements in sleep quality (SMD = 0.56, 95% CI = 0.40, 0.72) and insomnia severity (SMD = -0.90, 95% CI = -1.14, -0.65). Most subgroup analyses were not significant, suggesting that a variety of e- and m-Health interventions are effective across diverse age and health populations. These interventions offer scalable and accessible approaches to help individuals adopt and sustain healthier behaviours, with implications for broader public health and healthcare challenges.
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Affiliation(s)
- Ben Singh
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia.
| | - Mavra Ahmed
- Department of Nutritional Sciences and Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amanda E Staiano
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Claire Gough
- Flinders University, College of Nursing and Health Sciences, Adelaide, SA, Australia
| | - Jasmine Petersen
- Flinders University: College of Education, Psychology and Social Work, Adelaide, SA, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
| | - Chelsea Kracht
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Christopher Huong
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Zenong Yin
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Maria F Vasiloglou
- Nestlé Institute of Health Sciences, Nestlé Research, 1000, Lausanne, Switzerland
| | - Chen-Chia Pan
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Department of Prevention and Health Promotion, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences and Melbourne School of Health Sciences (jointly appointed), University of Melbourne, Parkville, VIC, Australia
| | - Matthew Mclaughlin
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Lauren von Klinggraeff
- Department of Community and Behavioral Health Sciences, Institute of Public and Preventive Health, School of Public Health, Augusta University, Augusta, GA, USA
| | - Christopher D Pfledderer
- Department of Health Promotion and Behavorial Sciences, University of Texas Health Science Center Houston, School of Public Health in Austin, Austin, TX, USA
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Alyssa M Button
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Carol A Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
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Coates PM, Bailey RL, Blumberg JB, El-Sohemy A, Floyd ZE, Goldenberg JZ, Gould Shunney A, Holscher HD, Nkrumah-Elie Y, Rai D, Ritz BW, Weber WJ. The Evolution of Science and Regulation of Dietary Supplements: Past, Present, and Future. J Nutr 2024:S0022-3166(24)00356-0. [PMID: 38971530 DOI: 10.1016/j.tjnut.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024] Open
Abstract
Dietary supplement use in the United States is widespread and increasing, especially among certain population groups, such as older Americans. The science surrounding dietary supplements has evolved substantially over the last few decades since their formal regulation in 1994. Much has been learned about the mechanisms of action of many dietary supplement ingredients, but the evidence on their health effects is still building. As is true of much nutrition research, there are many studies that point to health effects, but not all are at the level of scientific evidence (e.g., randomized controlled interventions), rigor, or quality needed for definitive statements of efficacy regarding clinical end points. New technologies and approaches are being applied to the science of dietary supplements, including nutrigenomics and microbiome analysis, data science, artificial intelligence (AI), and machine learning-all of which can elevate the science behind dietary supplements. Products can contain an array of bioactive compounds derived from foods as well as from medicinal plants, which creates enormous challenges in data collection and management. Clinical applications, particularly those aimed at providing personalized nutrition options for patients, have become more sophisticated as dietary supplements are incorporated increasingly into clinical practice and self-care. The goals of this article are to provide historical context for the regulation and science of dietary supplements, identify research resources, and suggest some future directions for science in this field.
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Affiliation(s)
- Paul M Coates
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, United States.
| | - Regan L Bailey
- Institute for Advancing Health Through Agriculture, Texas A&M University System, College Station, TX, United States
| | - Jeffrey B Blumberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Z Elizabeth Floyd
- McIlhenny Botanical Research Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Joshua Z Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, United States
| | | | - Hannah D Holscher
- Department of Food Science and Human Nutrition, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | | | - Deshanie Rai
- OmniActive Health Technologies, Morristown, NJ, United States
| | - Barry W Ritz
- Nestlé Health Science, Bridgewater, NJ, United States
| | - Wendy J Weber
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, United States
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6
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Chan PSF, Fang Y, Cheung DH, Zhang Q, Sun F, Mo PKH, Wang Z. Effectiveness of chatbots in increasing uptake, intention, and attitudes related to any type of vaccination: A systematic review and meta-analysis. Appl Psychol Health Well Being 2024. [PMID: 38886054 DOI: 10.1111/aphw.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
This systematic review and meta-analysis analyzed and summarized the growing literature on the effectiveness of chatbot-delivered interventions in increasing uptake, intention, and attitudes related to any type of vaccination. We identified randomized controlled studies (RCTs), quasi-experimental studies, and non-experimental studies from the following platforms: PubMed, Web of Science, MEDLINE, Global Health, APA PsycInfo, and EMBASE databases. A total of 12 eligible studies published from 2019 to 2023 were analyzed and summarized. In particular, one RCT showed that a chatbot-delivered tailored intervention was more effective than a chatbot-delivered non-tailored intervention in promoting seasonal influenza vaccine uptake among older adults (50.5% versus 35.3%, p = 0.002). Six RCTs were included in the meta-analysis to evaluate the effectiveness of chatbot interventions to improve vaccination attitudes and intentions. The pooled standard mean difference (SMD) of overall attitude change was 0.34 (95% confidence intervals [CI]: 0.13, 0.55, p = 0.001). We found a non-significant trivial effect of chatbot interventions on improving intentions of vaccination (SMD: 0.11, 95% CI: -0.13, 0.34, p = 0.38). However, further evidence is needed to draw a more precise conclusion. Additionally, study participants reported high satisfaction levels of using the chatbot and were likely to recommend it to others. The development of chatbots is still nascent and rooms for improvement exist.
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Affiliation(s)
- Paul Shing-Fong Chan
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yuan Fang
- Department of Health and Physical Education, the Education University of Hong Kong, Hong Kong, SAR, China
| | - Doug H Cheung
- Center of Population Sciences for Health Equity, Florida State University, Tallahassee, FL, USA
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, the University of Hong Kong, Hong Kong, SAR, China
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, SAR, China
| | - Fenghua Sun
- Department of Health and Physical Education, the Education University of Hong Kong, Hong Kong, SAR, China
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
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Zhang F, Liu X, Wu W, Zhu S. Evolution of Chatbots in Nursing Education: Narrative Review. JMIR MEDICAL EDUCATION 2024; 10:e54987. [PMID: 38889074 PMCID: PMC11186796 DOI: 10.2196/54987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/16/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
Background The integration of chatbots in nursing education is a rapidly evolving area with potential transformative impacts. This narrative review aims to synthesize and analyze the existing literature on chatbots in nursing education. Objective This study aims to comprehensively examine the temporal trends, international distribution, study designs, and implications of chatbots in nursing education. Methods A comprehensive search was conducted across 3 databases (PubMed, Web of Science, and Embase) following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Results A total of 40 articles met the eligibility criteria, with a notable increase of publications in 2023 (n=28, 70%). Temporal analysis revealed a notable surge in publications from 2021 to 2023, emphasizing the growing scholarly interest. Geographically, Taiwan province made substantial contributions (n=8, 20%), followed by the United States (n=6, 15%) and South Korea (n=4, 10%). Study designs varied, with reviews (n=8, 20%) and editorials (n=7, 18%) being predominant, showcasing the richness of research in this domain. Conclusions Integrating chatbots into nursing education presents a promising yet relatively unexplored avenue. This review highlights the urgent need for original research, emphasizing the importance of ethical considerations.
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Affiliation(s)
- Fang Zhang
- Department of Science and Education, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Xiaoliu Liu
- Medical Laboratory of Shenzhen Luohu People’s Hospital, Shenzhen, China
| | - Wenyan Wu
- Medical Laboratory of Shenzhen Luohu People’s Hospital, Shenzhen, China
| | - Shiben Zhu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
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Maher C, Singh B, Wylde A, Chastin S. Virtual health assistants: a grand challenge in health communications and behavior change. Front Digit Health 2024; 6:1418695. [PMID: 38827384 PMCID: PMC11140094 DOI: 10.3389/fdgth.2024.1418695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Affiliation(s)
- Carol Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Ben Singh
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Allison Wylde
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Sebastien Chastin
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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Veneziani I, Grimaldi A, Marra A, Morini E, Culicetto L, Marino S, Quartarone A, Maresca G. Towards a Deeper Understanding: Utilizing Machine Learning to Investigate the Association between Obesity and Cognitive Decline-A Systematic Review. J Clin Med 2024; 13:2307. [PMID: 38673581 PMCID: PMC11051247 DOI: 10.3390/jcm13082307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/09/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Several studies have shown a relation between obesity and cognitive decline, highlighting a significant global health challenge. In recent years, artificial intelligence (AI) and machine learning (ML) have been integrated into clinical practice for analyzing datasets to identify new risk factors, build predictive models, and develop personalized interventions, thereby providing useful information to healthcare professionals. This systematic review aims to evaluate the potential of AI and ML techniques in addressing the relationship between obesity, its associated health consequences, and cognitive decline. Methods: Systematic searches were performed in PubMed, Cochrane, Web of Science, Scopus, Embase, and PsycInfo databases, which yielded eight studies. After reading the full text of the selected studies and applying predefined inclusion criteria, eight studies were included based on pertinence and relevance to the topic. Results: The findings underscore the utility of AI and ML in assessing risk and predicting cognitive decline in obese patients. Furthermore, these new technology models identified key risk factors and predictive biomarkers, paving the way for tailored prevention strategies and treatment plans. Conclusions: The early detection, prevention, and personalized interventions facilitated by these technologies can significantly reduce costs and time. Future research should assess ethical considerations, data privacy, and equitable access for all.
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Affiliation(s)
- Isabella Veneziani
- Department of Nervous System and Behavioural Sciences, Psychology Section, University of Pavia, Piazza Botta, 11, 27100 Pavia, Italy (A.G.)
| | - Alessandro Grimaldi
- Department of Nervous System and Behavioural Sciences, Psychology Section, University of Pavia, Piazza Botta, 11, 27100 Pavia, Italy (A.G.)
| | - Angela Marra
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.M.); (E.M.); (S.M.); (A.Q.); (G.M.)
| | - Elisabetta Morini
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.M.); (E.M.); (S.M.); (A.Q.); (G.M.)
| | - Laura Culicetto
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.M.); (E.M.); (S.M.); (A.Q.); (G.M.)
| | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.M.); (E.M.); (S.M.); (A.Q.); (G.M.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.M.); (E.M.); (S.M.); (A.Q.); (G.M.)
| | - Giuseppa Maresca
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo C. da Casazza, 98124 Messina, Italy; (A.M.); (E.M.); (S.M.); (A.Q.); (G.M.)
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Muse ED, Topol EJ. Transforming the cardiometabolic disease landscape: Multimodal AI-powered approaches in prevention and management. Cell Metab 2024; 36:670-683. [PMID: 38428435 PMCID: PMC10990799 DOI: 10.1016/j.cmet.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
The rise of artificial intelligence (AI) has revolutionized various scientific fields, particularly in medicine, where it has enabled the modeling of complex relationships from massive datasets. Initially, AI algorithms focused on improved interpretation of diagnostic studies such as chest X-rays and electrocardiograms in addition to predicting patient outcomes and future disease onset. However, AI has evolved with the introduction of transformer models, allowing analysis of the diverse, multimodal data sources existing in medicine today. Multimodal AI holds great promise in more accurate disease risk assessment and stratification as well as optimizing the key driving factors in cardiometabolic disease: blood pressure, sleep, stress, glucose control, weight, nutrition, and physical activity. In this article we outline the current state of medical AI in cardiometabolic disease, highlighting the potential of multimodal AI to augment personalized prevention and treatment strategies in cardiometabolic disease.
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Affiliation(s)
- Evan D Muse
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA 92037, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA 92037, USA
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA 92037, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA 92037, USA.
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Robinson CL, D'Souza RS, Yazdi C, Diejomaoh EM, Schatman ME, Emerick T, Orhurhu V. Reviewing the Potential Role of Artificial Intelligence in Delivering Personalized and Interactive Pain Medicine Education for Chronic Pain Patients. J Pain Res 2024; 17:923-929. [PMID: 38464902 PMCID: PMC10924768 DOI: 10.2147/jpr.s439452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
The integration of artificial intelligence (AI) in patient pain medicine education has the potential to revolutionize pain management. By harnessing the power of AI, patient education becomes more personalized, interactive, and supportive, empowering patients to understand their pain, make informed decisions, and actively participate in their pain management journey. AI tailors the educational content to individual patients' needs, providing personalized recommendations. It introduces interactive elements through chatbots and virtual assistants, enhancing engagement and motivation. AI-powered platforms improve accessibility by providing easy access to educational resources and adapting content to diverse patient populations. Future AI applications in pain management include explaining pain mechanisms, treatment options, predicting outcomes based on individualized patient-specific factors, and supporting monitoring and adherence. Though the literature on AI in pain medicine and its applications are scarce yet growing, we propose avenues where AI may be applied and review the potential applications of AI in pain management education. Additionally, we address ethical considerations, patient empowerment, and accessibility barriers.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Efemena M Diejomaoh
- Department of Psychiatry & Behavioral Science, Meharry Medical College, Nashville, TN, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
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Dergaa I, Saad HB, El Omri A, Glenn JM, Clark CCT, Washif JA, Guelmami N, Hammouda O, Al-Horani RA, Reynoso-Sánchez LF, Romdhani M, Paineiras-Domingos LL, Vancini RL, Taheri M, Mataruna-Dos-Santos LJ, Trabelsi K, Chtourou H, Zghibi M, Eken Ö, Swed S, Aissa MB, Shawki HH, El-Seedi HR, Mujika I, Seiler S, Zmijewski P, Pyne DB, Knechtle B, Asif IM, Drezner JA, Sandbakk Ø, Chamari K. Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI's GPT-4 model. Biol Sport 2024; 41:221-241. [PMID: 38524814 PMCID: PMC10955739 DOI: 10.5114/biolsport.2024.133661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 03/26/2024] Open
Abstract
The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.
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Affiliation(s)
- Ismail Dergaa
- Primary Health Care Corporation (PHCC), Doha, Qatar
- Research Laboratory Education, Motricité, Sport et Santé (EM2S) LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
- High Institute of Sport and Physical Education of Kef, Jendouba, Kef, Tunisia
| | - Helmi Ben Saad
- University of Sousse, Farhat HACHED hospital, Research Laboratory LR12SP09 «Heart Failure», Sousse, Tunisia
- University of Sousse, Faculty of Medicine of Sousse, laboratory of Physiology, Sousse, Tunisia
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Cain C. T. Clark
- College of Life Sciences, Birmingham City University, Birmingham, B15 3TN, UK
- Institute for Health and Wellbeing, Coventry University, Coventry, CV1 5FB, UK
| | - Jad Adrian Washif
- Sports Performance Division, National Sports Institute of Malaysia, Kuala Lumpur, Malaysia
| | - Noomen Guelmami
- High Institute of Sport and Physical Education of Kef, Jendouba, Kef, Tunisia
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Omar Hammouda
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS (Faculty of Sport Sciences), UPL, Paris Nanterre University, Nanterre, France
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Tunisia
| | | | | | - Mohamed Romdhani
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS (Faculty of Sport Sciences), UPL, Paris Nanterre University, Nanterre, France
| | | | - Rodrigo L. Vancini
- Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Morteza Taheri
- Department of Motor Behavior, Faculty of Sport Sciences, University of Tehran, Tehran, Iran
| | - Leonardo Jose Mataruna-Dos-Santos
- Department of Creative Industries, Faculty of Communication, Arts and Sciences, Canadian University of Dubai, Dubai, United Arab Emirates
| | - Khaled Trabelsi
- Research Laboratory Education, Motricité, Sport et Santé (EM2S) LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
| | - Hamdi Chtourou
- Research Laboratory Education, Motricité, Sport et Santé (EM2S) LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
| | - Makram Zghibi
- High Institute of Sport and Physical Education of Kef, Jendouba, Kef, Tunisia
| | - Özgür Eken
- Department of Physical Education and Sport Teaching, Inonu University, Malatya 44000, Turkey
| | - Sarya Swed
- University of Aleppo Faculty of Medicine: Aleppo, Aleppo Governorate, Syria
| | - Mohamed Ben Aissa
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Hossam H. Shawki
- Department of Comparative and Experimental Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hesham R. El-Seedi
- Department of Chemistry, Faculty of Science, Islamic University of Madinah, Madinah, 42351, Saudi Arabia
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
| | - Iñigo Mujika
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Leioa, Basque Country
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Stephen Seiler
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Piotr Zmijewski
- Jozef Pilsudski University of Physical Education in Warsaw, Warsaw, Poland
| | - David B. Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Irfan M Asif
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Øyvind Sandbakk
- Center for Elite Sports Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karim Chamari
- Higher institute of Sport and Physical Education, ISSEP Ksar Saïd, Manouba University, Tunisia
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Chen Y, Gao J, Petruc M, Hammer RD, Popescu M, Xu D. Iterative Prompt Refinement for Mining Gene Relationships from ChatGPT. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.23.573201. [PMID: 38187653 PMCID: PMC10769373 DOI: 10.1101/2023.12.23.573201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
ChatGPT has demonstrated its potential as a surrogate knowledge graph. Trained on extensive data sources, including open-access publications, peer-reviewed research articles and biomedical websites, ChatGPT extracted information on gene relationships and biological pathways. However, a major challenge is model hallucination, i.e., high false positive rates. To assess and address this challenge, we systematically evaluated ChatGPT's capacity for predicting gene relationships using GPT-3.5-turbo and GPT-4. Benchmarking against the KEGG Pathway Database as the ground truth, we experimented with diverse prompting strategies, targeting gene relationships of activation, inhibition, and phosphorylation. We introduced an innovative iterative prompt refinement technique. By assessing prompt efficacy using metrics like F-1 score, precision, and recall, GPT-4 was re-engaged to suggest improved prompts. A refined prompt, which combines a specialized role with explanatory text, significantly enhances the performance. Going beyond pairwise gene relationships, we also deciphered complex gene interplays, such as gene interaction chains and pathways pertinent to diseases like non-small cell lung cancer. Direct prompts showed limited success, but "least-to-most" prompting exhibited significant potentials for such network constructions. The methods in this study may be used for some other bioinformatics prediction problems.
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Affiliation(s)
- Yibo Chen
- Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri 65211, USA
| | - Jeffrey Gao
- Marriotts Ridge High School, Marriottsville, MD, 21104, USA
| | - Marius Petruc
- Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri 65211, USA
| | - Richard D Hammer
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri 65211, USA
| | - Mihail Popescu
- Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri, Columbia, MO 65211, USA
| | - Dong Xu
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, 65211, USA
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Li H, Zhang R, Lee YC, Kraut RE, Mohr DC. Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being. NPJ Digit Med 2023; 6:236. [PMID: 38114588 PMCID: PMC10730549 DOI: 10.1038/s41746-023-00979-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Conversational artificial intelligence (AI), particularly AI-based conversational agents (CAs), is gaining traction in mental health care. Despite their growing usage, there is a scarcity of comprehensive evaluations of their impact on mental health and well-being. This systematic review and meta-analysis aims to fill this gap by synthesizing evidence on the effectiveness of AI-based CAs in improving mental health and factors influencing their effectiveness and user experience. Twelve databases were searched for experimental studies of AI-based CAs' effects on mental illnesses and psychological well-being published before May 26, 2023. Out of 7834 records, 35 eligible studies were identified for systematic review, out of which 15 randomized controlled trials were included for meta-analysis. The meta-analysis revealed that AI-based CAs significantly reduce symptoms of depression (Hedge's g 0.64 [95% CI 0.17-1.12]) and distress (Hedge's g 0.7 [95% CI 0.18-1.22]). These effects were more pronounced in CAs that are multimodal, generative AI-based, integrated with mobile/instant messaging apps, and targeting clinical/subclinical and elderly populations. However, CA-based interventions showed no significant improvement in overall psychological well-being (Hedge's g 0.32 [95% CI -0.13 to 0.78]). User experience with AI-based CAs was largely shaped by the quality of human-AI therapeutic relationships, content engagement, and effective communication. These findings underscore the potential of AI-based CAs in addressing mental health issues. Future research should investigate the underlying mechanisms of their effectiveness, assess long-term effects across various mental health outcomes, and evaluate the safe integration of large language models (LLMs) in mental health care.
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Affiliation(s)
- Han Li
- Department of Communications and New Media, National University of Singapore, Singapore, 117416, Singapore
| | - Renwen Zhang
- Department of Communications and New Media, National University of Singapore, Singapore, 117416, Singapore.
| | - Yi-Chieh Lee
- Department of Computer Science, National University of Singapore, Singapore, 117416, Singapore
| | - Robert E Kraut
- Human-Computer Interaction Institute Carnegie Mellon University, Pittsburgh, PA, 15213, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, 60611, USA
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Beyeler M, Légeret C, Kiwitz F, van der Horst K. Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study. JMIR Hum Factors 2023; 10:e47913. [PMID: 37938894 PMCID: PMC10666014 DOI: 10.2196/47913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/09/2023] [Accepted: 09/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Currently, over 4000 bariatric procedures are performed annually in Switzerland. To improve outcomes, patients need to have good knowledge regarding postoperative nutrition. To potentially provide them with knowledge between dietetic consultations, a health bot (HB) was created. The HB can answer bariatric nutrition questions in writing based on artificial intelligence. OBJECTIVE This study aims to evaluate the usability and perception of the HB among patients receiving bariatric care. METHODS Patients before or after bariatric surgery tested the HB. A mixed methods approach was used, which consisted of a questionnaire and qualitative interviews before and after testing the HB. The dimensions usability of, usefulness of, satisfaction with, and ease of use of the HB, among others, were measured. Data were analyzed using R Studio (R Studio Inc) and Excel (Microsoft Corp). The interviews were transcribed and a summary inductive content analysis was performed. RESULTS A total of 12 patients (female: n=8, 67%; male: n=4, 33%) were included. The results showed excellent usability with a mean usability score of 87 (SD 12.5; range 57.5-100) out of 100. Other dimensions of acceptability included usefulness (mean 5.28, SD 2.02 out of 7), satisfaction (mean 5.75, SD 1.68 out of 7), and learnability (mean 6.26, SD 1.5 out of 7). The concept of the HB and availability of reliable nutrition information were perceived as desirable (mean 5.5, SD 1.64 out of 7). Weaknesses were identified in the response accuracy, limited knowledge, and design of the HB. CONCLUSIONS The HB's ease of use and usability were evaluated to be positive; response accuracy, topic selection, and design should be optimized in a next step. The perceptions of nutrition professionals and the impact on patient care and the nutrition knowledge of participants need to be examined in further studies.
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Affiliation(s)
- Marina Beyeler
- Nutrition and Dietetics, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Oviva AG, Altendorf, Switzerland
| | | | - Fabian Kiwitz
- Business Information Technology, Zürich University of Applied Sciences, Zürich, Switzerland
- KIRATIK GmbH, Sigmaringen, Germany
| | - Klazine van der Horst
- Nutrition and Dietetics, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Ashton LM, Adam MT, Whatnall M, Rollo ME, Burrows TL, Hansen V, Collins CE. Exploring the design and utility of an integrated web-based chatbot for young adults to support healthy eating: a qualitative study. Int J Behav Nutr Phys Act 2023; 20:119. [PMID: 37794368 PMCID: PMC10548711 DOI: 10.1186/s12966-023-01511-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND There is a lack of understanding of the potential utility of a chatbot integrated into a website to support healthy eating among young adults. Therefore, the aim was to interview key informants regarding potential utility and design of a chatbot to: (1) increase young adults' return rates and engagement with a purpose-built healthy eating website and, (2) improve young adults' diet quality. METHODS Eighteen qualitative, semi-structured interviews were conducted across three stakeholder groups: (i) experts in dietary behaviour change in young adults (n = 6), (ii) young adult users of a healthy eating website (n = 7), and (iii) experts in chatbot design (n = 5). Interview questions were guided by a behaviour change framework and a template analysis was conducted using NVivo. RESULTS Interviewees identified three potential roles of a chatbot for supporting healthy eating in young adults; R1: improving healthy eating knowledge and facilitating discovery, R2: reducing time barriers related to healthy eating, R3: providing support and social engagement. To support R1, the following features were suggested: F1: chatbot generated recommendations and F2: triage to website information or externally (e.g., another website) to address current user needs. For R2, suggested features included F3: nudge or behavioural prompts at critical moments and F4: assist users to navigate healthy eating websites. Finally, to support R3 interviewees recommended the following features: F5: enhance interactivity, F6: offer useful anonymous support, F7: facilitate user connection with content in meaningful ways and F8: outreach adjuncts to website (e.g., emails). Additional 'general' chatbot features included authenticity, personalisation and effective and strategic development, while the preferred chatbot style and language included tailoring (e.g., age and gender), with a positive and professional tone. Finally, the preferred chatbot message subjects included training (e.g., would you like to see a video to make this recipe?), enablement (e.g., healthy eating doesn't need to be expensive, we've created a budget meal plan, want to see?) and education or informative approaches (e.g., "Did you know bananas are high in potassium which can aid in reducing blood pressure?"). CONCLUSION Findings can guide chatbot designers and nutrition behaviour change researchers on potential chatbot roles, features, style and language and messaging in order to support healthy eating knowledge and behaviours in young adults.
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Affiliation(s)
- Lee M Ashton
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, 2308, Callaghan, NSW, Australia
- School of Education, College of Human and Social Futures, University of Newcastle, 2308, Callaghan, NSW, Australia
- Active Living Research Program, Hunter Medical Research Institute, 2305, New Lambton Heights, NSW, Australia
| | - Marc Tp Adam
- Food and Nutrition Research Program, Hunter Medical Research Institute, 2305, New Lambton Heights, NSW, Australia
- School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, 2308, Callaghan, NSW, Australia
| | - Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, 2308, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, 2305, New Lambton Heights, NSW, Australia
| | - Megan E Rollo
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, 6845, Perth, WA, Australia
| | - Tracy L Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, 2308, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, 2305, New Lambton Heights, NSW, Australia
| | - Vibeke Hansen
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, 2308, Callaghan, NSW, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, 2308, Callaghan, NSW, Australia.
- Food and Nutrition Research Program, Hunter Medical Research Institute, 2305, New Lambton Heights, NSW, Australia.
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Wang Z, Chan PSF, Fang Y, Yu FY, Ye D, Zhang Q, Wong MCS, Mo PKH. Chatbot-Delivered Online Intervention to Promote Seasonal Influenza Vaccination During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2332568. [PMID: 37695585 PMCID: PMC10495860 DOI: 10.1001/jamanetworkopen.2023.32568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/30/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Receiving seasonal influenza vaccination (SIV) is important for adults during the COVID-19 pandemic. There are few robust evaluations of tailored interventions for improving SIV uptake among adults 65 years or older. Objective To evaluate the relative efficacy of a stages of change (SOC)-tailored online intervention compared with a standard, non-SOC-tailored online intervention in increasing SIV uptake among Hong Kong residents 65 years or older. Design, Setting, and Participants This nonblinded parallel-group randomized clinical trial was conducted between December 1, 2021, and July 31, 2022, in Hong Kong, China. Eligible participants were 65 years or older, had Cantonese- and/or Mandarin-speaking skills, were community-dwelling, had Hong Kong residency, were smartphone users, and had not received SIV for the 2021 to 2022 influenza season. Participants were recruited through random telephone calls, and those who completed the baseline telephone survey were randomized to either the intervention or control group. Both complete case and intention-to-treat (ITT) analyses were performed. Intervention In the intervention group, a simplified rule-based chatbot first assessed participants' SOC related to SIV uptake and then automatically selected and sent participants SOC-tailored online health promotion messages (videos) through a messaging application (WhatsApp; Meta) once every 2 weeks for 4 sessions. In the control group, the chatbot sent a link to access through the messaging application a standard online health promotion message (video) covering general SIV information every 2 weeks for 4 sessions. Main Outcomes and Measures The primary outcome was self-reported SIV uptake at month 6, which was validated by the research team. The secondary outcome was SOC measured at both baseline and month 6 by validated questions. Results A total of 396 participants (mean [SD] age of 70.2 [4.3] years; 249 females [62.9%]) were randomized to the intervention (n = 198) or control (n = 198) group. The ITT analysis showed that the validated SIV uptake rate was higher in the intervention group than the control group at month 6 (50.5% vs 35.3%; P = .002). The mean (SD) SOC score was higher in the intervention group than the control group (2.8 [1.4] vs 2.4 [1.4]; P = .02). More participants in the intervention group completed at least 1 episode of intervention than in the control group (77.3% vs 62.6%; P < .001). Conclusions Results of this trial indicate that the SOC-tailored online intervention was more effective than the non-SOC-tailored intervention and may be a sustainable new method in increasing SIV uptake among adults 65 years or older. Trial Registration ClinicalTrials.gov Identifier: NCT05155241.
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Affiliation(s)
- Zixin Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Paul Shing-fong Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Fuk-yuen Yu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Danhua Ye
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Martin C. S. Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Phoenix K. H. Mo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ollier J, Suryapalli P, Fleisch E, von Wangenheim F, Mair JL, Salamanca-Sanabria A, Kowatsch T. Can digital health researchers make a difference during the pandemic? Results of the single-arm, chatbot-led Elena+: Care for COVID-19 interventional study. Front Public Health 2023; 11:1185702. [PMID: 37693712 PMCID: PMC10485275 DOI: 10.3389/fpubh.2023.1185702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
Background The current paper details findings from Elena+: Care for COVID-19, an app developed to tackle the collateral damage of lockdowns and social distancing, by offering pandemic lifestyle coaching across seven health areas: anxiety, loneliness, mental resources, sleep, diet and nutrition, physical activity, and COVID-19 information. Methods The Elena+ app functions as a single-arm interventional study, with participants recruited predominantly via social media. We used paired samples T-tests and within subjects ANOVA to examine changes in health outcome assessments and user experience evaluations over time. To investigate the mediating role of behavioral activation (i.e., users setting behavioral intentions and reporting actual behaviors) we use mixed-effect regression models. Free-text entries were analyzed qualitatively. Results Results show strong demand for publicly available lifestyle coaching during the pandemic, with total downloads (N = 7'135) and 55.8% of downloaders opening the app (n = 3,928) with 9.8% completing at least one subtopic (n = 698). Greatest areas of health vulnerability as assessed with screening measures were physical activity with 62% (n = 1,000) and anxiety with 46.5% (n = 760). The app was effective in the treatment of mental health; with a significant decrease in depression between first (14 days), second (28 days), and third (42 days) assessments: F2,38 = 7.01, p = 0.003, with a large effect size (η2G = 0.14), and anxiety between first and second assessments: t54 = 3.7, p = <0.001 with a medium effect size (Cohen d = 0.499). Those that followed the coaching program increased in net promoter score between the first and second assessment: t36 = 2.08, p = 0.045 with a small to medium effect size (Cohen d = 0.342). Mediation analyses showed that while increasing number of subtopics completed increased behavioral activation (i.e., match between behavioral intentions and self-reported actual behaviors), behavioral activation did not mediate the relationship to improvements in health outcome assessments. Conclusions Findings show that: (i) there is public demand for chatbot led digital coaching, (ii) such tools can be effective in delivering treatment success, and (iii) they are highly valued by their long-term user base. As the current intervention was developed at rapid speed to meet the emergency pandemic context, the future looks bright for other public health focused chatbot-led digital health interventions.
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Affiliation(s)
- Joseph Ollier
- Mobiliar Lab for Analytics, Chair of Technology Marketing, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Pavani Suryapalli
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Chair of Information Management, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Florian von Wangenheim
- Mobiliar Lab for Analytics, Chair of Technology Marketing, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Chair of Information Management, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Jacqueline Louise Mair
- Centre for Digital Health Interventions, Chair of Information Management, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alicia Salamanca-Sanabria
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Chair of Information Management, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
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