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Kostenius C, Lindstrom F, Potts C, Pekkari N. Young peoples' reflections about using a chatbot to promote their mental wellbeing in northern periphery areas - a qualitative study. Int J Circumpolar Health 2024; 83:2369349. [PMID: 38912845 PMCID: PMC11198148 DOI: 10.1080/22423982.2024.2369349] [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: 11/28/2023] [Accepted: 06/13/2024] [Indexed: 06/25/2024] Open
Abstract
An international research collaboration with researchers from northern Sweden, Finland, Ireland, Northern Ireland, Scotland and developed the ChatPal chatbot to explore the possibility of a multilingual chatbot to promote mental wellbeing in people of all ages. In Sweden the end users were young people. The aim of the current study was to explore and discuss Swedish young peoples' experiences of using a chatbot designed to promote their mental wellbeing. Young people aged 15-19 filled out an open-ended survey giving feedback on the ChatPal chatbot and their suggestions on improvements. A total of 122 survey responses were analysed. The qualitative content analysis of the survey responses resulted in three themes each containing two to three sub-themes. Theme 1, feeling as if someone is there when needed, which highlighted positive aspects regarding availability and accessibility. Theme 2, human-robot interaction has its limitations, which included aspects such as unnatural and impersonal conversations and limited content availability. Theme 3, usability can be improved, given technical errors due to lack of internet connection and difficulty navigating the chatbot were brought up as issues. The findings are discussed, and potential implications are offered for those designing and developing digital mental health technologies for young people.
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Affiliation(s)
| | - Frida Lindstrom
- Health Sciences, Luleå University of Technology, Luleå, Sweden
| | | | - Niklas Pekkari
- Health Sciences, Luleå University of Technology, Luleå, Sweden
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Schillings C, Meißner E, Erb B, Bendig E, Schultchen D, Pollatos O. Effects of a Chatbot-Based Intervention on Stress and Health-Related Parameters in a Stressed Sample: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e50454. [PMID: 38805259 PMCID: PMC11167325 DOI: 10.2196/50454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 02/09/2024] [Accepted: 03/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Stress levels and the prevalence of mental disorders in the general population have been rising in recent years. Chatbot-based interventions represent novel and promising digital approaches to improve health-related parameters. However, there is a lack of research on chatbot-based interventions in the area of mental health. OBJECTIVE The aim of this study was to investigate the effects of a 3-week chatbot-based intervention guided by the chatbot ELME, specifically with respect to the ability to reduce stress and improve various health-related parameters in a stressed sample. METHODS In this multicenter two-armed randomized controlled trial, 118 individuals with medium to high stress levels were randomized to the intervention group (n=59) or the treatment-as-usual control group (n=59). The ELME chatbot guided participants of the intervention group through 3 weeks of training based on the topics stress, mindfulness, and interoception, with practical and psychoeducative elements delivered in two daily interactive intervention sessions via a smartphone (approximately 10-20 minutes each). The primary outcome (perceived stress) and secondary outcomes (mindfulness; interoception or interoceptive sensibility; subjective well-being; and emotion regulation, including the subfacets reappraisal and suppression) were assessed preintervention (T1), post intervention (T2; after 3 weeks), and at follow-up (T3; after 6 weeks). During both conditions, participants also underwent ecological momentary assessments of stress and interoceptive sensibility. RESULTS There were no significant changes in perceived stress (β03=-.018, SE=.329; P=.96) and momentary stress. Mindfulness and the subfacet reappraisal significantly increased in the intervention group over time, whereas there was no change in the subfacet suppression. Well-being and momentary interoceptive sensibility increased in both groups over time. CONCLUSIONS To gain insight into how the intervention can be improved to achieve its full potential for stress reduction, besides a longer intervention duration, specific sample subgroups should be considered. The chatbot-based intervention seems to have the potential to improve mindfulness and emotion regulation in a stressed sample. Future chatbot-based studies and interventions in health care should be designed based on the latest findings on the efficacy of rule-based and artificial intelligence-based chatbots. TRIAL REGISTRATION German Clinical Trials Register DRKS00027560; https://drks.de/search/en/trial/DRKS00027560. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-doi.org/10.3389/fdgth.2023.1046202.
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Affiliation(s)
- Christine Schillings
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Echo Meißner
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Benjamin Erb
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Balan R, Dobrean A, Poetar CR. Use of automated conversational agents in improving young population mental health: a scoping review. NPJ Digit Med 2024; 7:75. [PMID: 38503909 PMCID: PMC10951258 DOI: 10.1038/s41746-024-01072-1] [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: 08/19/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
Automated conversational agents (CAs) emerged as a promising solution in mental health interventions among young people. Therefore, the objective of this scoping review is to examine the current state of research into fully automated CAs mediated interventions for the emotional component of mental health among young people. Selected databases were searched in March 2023. Included studies were primary research, reporting on development, feasibility/usability, or evaluation of fully automated CAs as a tool to improve the emotional component of mental health among young population. Twenty-five studies were included (N = 1707). Most automated CAs applications were standalone preventions targeting anxiety and depression. Automated CAs were predominantly AI-based chatbots, using text as the main communication channel. Overall, the results of the current scoping review showed that automated CAs mediated interventions for emotional problems are acceptable, engaging and with high usability. However, the results for clinical efficacy are far less conclusive, since almost half of evaluation studies reported no significant effect on emotional mental health outcomes. Based on these findings, it can be concluded that there is a pressing need to improve the existing automated CAs applications to increase their efficacy as well as conducting more rigorous methodological research in this area.
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Affiliation(s)
- Raluca Balan
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Cluj, Romania
| | - Anca Dobrean
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania.
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Cluj, Romania.
| | - Costina R Poetar
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Cluj, Romania
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Totzeck C, van der Meer AS, Christiansen H, Durlach F, Li Sanchez K, Schneider S. Systematic Review: Patient and Public Involvement of Children and Young People in Mental Health Research. Clin Child Fam Psychol Rev 2024; 27:257-274. [PMID: 38402358 PMCID: PMC10920437 DOI: 10.1007/s10567-024-00470-x] [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] [Accepted: 02/03/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Patient and public involvement (PPI) is an essential ethical component in mental health research, and represents a major opportunity to improve translational mental health research. The goals of this review were to (1) provide a comprehensive overview of empirical research focusing on PPI of children and young people (CYP) in mental health research studies; (2) evaluate the results with CYP and parents of those affected; and (3) derive recommendations for PPI of CYP in future mental health research studies. METHODS Based on an extensive literature review following the PRISMA guidelines, studies including CYP (age range: 0-21 years) in mental health research were identified and examined along a two-part analysis process considering their usability for mental health research. The conclusions drawn from the studies concerning CYP involvement were summarized and recommendations derived. RESULTS Overall, 19 articles reported PPI of CYP (age range: 10-26 years) in mental health research and were included for further analyses. The integrated studies differed in the type of PPI, and in the way the participation and involvement processes were presented. CONCLUSION Progress has been made in engaging CYP in mental health research, but there is a need for international standards, operationalization, and evaluation measures. Future research should go beyond merely reporting the PPI process itself. It should clearly indicate how and to what extent feedback from these PPI members was incorporated throughout the research process.
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Affiliation(s)
- Christina Totzeck
- Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Massenbergstrasse 9-13, 44787, Bochum, Germany.
- German Center for Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Bochum, Germany.
| | - Anna Swantje van der Meer
- Department of Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- German Center for Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Bochum, Germany
| | - Hanna Christiansen
- Department of Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- German Center for Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Bochum, Germany
| | - Friederike Durlach
- Department of Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Kira Li Sanchez
- Department of Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Massenbergstrasse 9-13, 44787, Bochum, Germany
- German Center for Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Bochum, Germany
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Ma Y, Achiche S, Pomey MP, Paquette J, Adjtoutah N, Vicente S, Engler K, Laymouna M, Lessard D, Lemire B, Asselah J, Therrien R, Osmanlliu E, Zawati MH, Joly Y, Lebouché B. Adapting and Evaluating an AI-Based Chatbot Through Patient and Stakeholder Engagement to Provide Information for Different Health Conditions: Master Protocol for an Adaptive Platform Trial (the MARVIN Chatbots Study). JMIR Res Protoc 2024; 13:e54668. [PMID: 38349734 PMCID: PMC10900097 DOI: 10.2196/54668] [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: 11/18/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI)-based chatbots could help address some of the challenges patients face in acquiring information essential to their self-health management, including unreliable sources and overburdened health care professionals. Research to ensure the proper design, implementation, and uptake of chatbots is imperative. Inclusive digital health research and responsible AI integration into health care require active and sustained patient and stakeholder engagement, yet corresponding activities and guidance are limited for this purpose. OBJECTIVE In response, this manuscript presents a master protocol for the development, testing, and implementation of a chatbot family in partnership with stakeholders. This protocol aims to help efficiently translate an initial chatbot intervention (MARVIN) to multiple health domains and populations. METHODS The MARVIN chatbots study has an adaptive platform trial design consisting of multiple parallel individual chatbot substudies with four common objectives: (1) co-construct a tailored AI chatbot for a specific health care setting, (2) assess its usability with a small sample of participants, (3) measure implementation outcomes (usability, acceptability, appropriateness, adoption, and fidelity) within a large sample, and (4) evaluate the impact of patient and stakeholder partnerships on chatbot development. For objective 1, a needs assessment will be conducted within the setting, involving four 2-hour focus groups with 5 participants each. Then, a co-construction design committee will be formed with patient partners, health care professionals, and researchers who will participate in 6 workshops for chatbot development, testing, and improvement. For objective 2, a total of 30 participants will interact with the prototype for 3 weeks and assess its usability through a survey and 3 focus groups. Positive usability outcomes will lead to the initiation of objective 3, whereby the public will be able to access the chatbot for a 12-month real-world implementation study using web-based questionnaires to measure usability, acceptability, and appropriateness for 150 participants and meta-use data to inform adoption and fidelity. After each objective, for objective 4, focus groups will be conducted with the design committee to better understand their perspectives on the engagement process. RESULTS From July 2022 to October 2023, this master protocol led to four substudies conducted at the McGill University Health Centre or the Centre hospitalier de l'Université de Montréal (both in Montreal, Quebec, Canada): (1) MARVIN for HIV (large-scale implementation expected in mid-2024), (2) MARVIN-Pharma for community pharmacists providing HIV care (usability study planned for mid-2024), (3) MARVINA for breast cancer, and (4) MARVIN-CHAMP for pediatric infectious conditions (both in preparation, with development to begin in early 2024). CONCLUSIONS This master protocol offers an approach to chatbot development in partnership with patients and health care professionals that includes a comprehensive assessment of implementation outcomes. It also contributes to best practice recommendations for patient and stakeholder engagement in digital health research. TRIAL REGISTRATION ClinicalTrials.gov NCT05789901; https://classic.clinicaltrials.gov/ct2/show/NCT05789901. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54668.
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Affiliation(s)
- Yuanchao Ma
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
- Centre for Outcomes Research & 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 Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sofiane Achiche
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
| | - Jesseca Paquette
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Nesrine Adjtoutah
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Serge Vicente
- Centre for Outcomes Research & 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
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research & 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
| | - Moustafa Laymouna
- Centre for Outcomes Research & 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
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David Lessard
- Centre for Outcomes Research & 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 Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Benoît Lemire
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jamil Asselah
- Department of Medicine, Division of Medical Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Rachel Therrien
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Esli Osmanlliu
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research & 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 Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Cho YM, Rai S, Ungar L, Sedoc J, Guntuku SC. An Integrative Survey on Mental Health Conversational Agents to Bridge Computer Science and Medical Perspectives. PROCEEDINGS OF THE CONFERENCE ON EMPIRICAL METHODS IN NATURAL LANGUAGE PROCESSING. CONFERENCE ON EMPIRICAL METHODS IN NATURAL LANGUAGE PROCESSING 2023; 2023:11346-11369. [PMID: 38618627 PMCID: PMC11010238 DOI: 10.18653/v1/2023.emnlp-main.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Mental health conversational agents (a.k.a. chatbots) are widely studied for their potential to offer accessible support to those experiencing mental health challenges. Previous surveys on the topic primarily consider papers published in either computer science or medicine, leading to a divide in understanding and hindering the sharing of beneficial knowledge between both domains. To bridge this gap, we conduct a comprehensive literature review using the PRISMA framework, reviewing 534 papers published in both computer science and medicine. Our systematic review reveals 136 key papers on building mental health-related conversational agents with diverse characteristics of modeling and experimental design techniques. We find that computer science papers focus on LLM techniques and evaluating response quality using automated metrics with little attention to the application while medical papers use rule-based conversational agents and outcome metrics to measure the health outcomes of participants. Based on our findings on transparency, ethics, and cultural heterogeneity in this review, we provide a few recommendations to help bridge the disciplinary divide and enable the cross-disciplinary development of mental health conversational agents.
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Njogu J, Jaworski G, Oduor C, Chea A, Malmqvist A, Rothschild CW. Assessing acceptability and effectiveness of a pleasure-oriented sexual and reproductive health chatbot in Kenya: an exploratory mixed-methods study. Sex Reprod Health Matters 2023; 31:2269008. [PMID: 37982143 PMCID: PMC11003647 DOI: 10.1080/26410397.2023.2269008] [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] [Indexed: 11/21/2023] Open
Abstract
Integrating pleasure may be a successful strategy for reaching young people with sexual and reproductive health and rights (SRHR) interventions. However, sexual pleasure-related programming and research remains sparse. We aimed to assess chatbot acceptability and describe changes in SRHR attitudes and behaviours among Kenyan young adults engaging with a pleasure-oriented SRHR chatbot. We used an exploratory mixed-methods study design. Between November 2021 and January 2022, participants completed a self-administered online questionnaire before and after chatbot engagement. In-depth phone interviews were conducted among a select group of participants after their initial chatbot engagement. Quantitative data were analysed using paired analyses and interviews were analysed using thematic content analysis. Of 301 baseline participants, 38% (115/301) completed the endline survey, with no measured baseline differences between participants who did and did not complete the endline survey. In-depth interviews were conducted among 41 participants. We observed higher satisfaction at endline vs. baseline on reported ability to exercise sexual rights (P ≤ 0.01), confidence discussing contraception (P ≤ 0.02) and sexual feelings/needs (P ≤ 0.001) with their sexual partner(s). Qualitative interviews indicated that most participants valued the chatbot as a confidential and free-of-judgment source of trustworthy "on-demand" SRHR information. Participants reported improvements in sex-positive communication with partners and safer sex practices due to new learnings from the chatbot. We observed increases in SRHR empowerment among young Kenyans after engagement with the chatbot. Integrating sexual pleasure into traditional SRHR content delivered through digital tools is a promising strategy to advance positive SRHR attitudes and practices among youth.
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Affiliation(s)
- Julius Njogu
- Evidence and Learning Advisor, Population Services International, Nairobi, Kenya
| | - Grace Jaworski
- Research Advisor, Population Services International, Washington, DC, USA
| | - Christine Oduor
- Head of Program Management, Digital Health and Monitoring, Population Services International, Nairobi, Kenya
| | | | - Alison Malmqvist
- Director of Sexual and Reproductive Health, Population Services International, Washington, DC, USA
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Nashwan AJ, Gharib S, Alhadidi M, El-Ashry AM, Alamgir A, Al-Hassan M, Khedr MA, Dawood S, Abufarsakh B. Harnessing Artificial Intelligence: Strategies for Mental Health Nurses in Optimizing Psychiatric Patient Care. Issues Ment Health Nurs 2023; 44:1020-1034. [PMID: 37850937 DOI: 10.1080/01612840.2023.2263579] [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] [Indexed: 10/19/2023]
Abstract
This narrative review explores the transformative impact of Artificial Intelligence (AI) on mental health nursing, particularly in enhancing psychiatric patient care. AI technologies present new strategies for early detection, risk assessment, and improving treatment adherence in mental health. They also facilitate remote patient monitoring, bridge geographical gaps, and support clinical decision-making. The evolution of virtual mental health assistants and AI-enhanced therapeutic interventions are also discussed. These technological advancements reshape the nurse-patient interactions while ensuring personalized, efficient, and high-quality care. The review also addresses AI's ethical and responsible use in mental health nursing, emphasizing patient privacy, data security, and the balance between human interaction and AI tools. As AI applications in mental health care continue to evolve, this review encourages continued innovation while advocating for responsible implementation, thereby optimally leveraging the potential of AI in mental health nursing.
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Affiliation(s)
- Abdulqadir J Nashwan
- Nursing Department, Hamad Medical Corporation, Doha, Qatar
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Suzan Gharib
- Nursing Department, Al-Khaldi Hospital, Amman, Jordan
| | - Majdi Alhadidi
- Psychiatric & Mental Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
| | | | | | | | | | - Shaimaa Dawood
- Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Aggarwal A, Tam CC, Wu D, Li X, Qiao S. Artificial Intelligence-Based Chatbots for Promoting Health Behavioral Changes: Systematic Review. J Med Internet Res 2023; 25:e40789. [PMID: 36826990 PMCID: PMC10007007 DOI: 10.2196/40789] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI)-based chatbots can offer personalized, engaging, and on-demand health promotion interventions. OBJECTIVE The aim of this systematic review was to evaluate the feasibility, efficacy, and intervention characteristics of AI chatbots for promoting health behavior change. METHODS A comprehensive search was conducted in 7 bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsycINFO, Web of Science, Embase, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated the feasibility or efficacy of AI chatbots for behavior change. The screening, extraction, and analysis of the identified articles were performed by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Of the 15 included studies, several demonstrated the high efficacy of AI chatbots in promoting healthy lifestyles (n=6, 40%), smoking cessation (n=4, 27%), treatment or medication adherence (n=2, 13%), and reduction in substance misuse (n=1, 7%). However, there were mixed results regarding feasibility, acceptability, and usability. Selected behavior change theories and expert consultation were used to develop the behavior change strategies of AI chatbots, including goal setting, monitoring, real-time reinforcement or 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 (eg, smartphones and Facebook Messenger). The participants also reported that AI chatbots offered a nonjudgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of the moderate to high risk of internal validity, insufficient description of AI techniques, and limitation for generalizability. CONCLUSIONS AI chatbots have demonstrated the efficacy of health behavior change interventions among large and diverse populations; however, future studies need to adopt robust randomized control trials to establish definitive conclusions.
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Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- SC SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, United States
| | - Cheuk Chi Tam
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- SC SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, United States
| | - Dezhi Wu
- UofSC Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, United States
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- SC SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, United States
- UofSC Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- SC SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, United States
- UofSC Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, United States
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Dosovitsky G, Bunge E. Development of a chatbot for depression: adolescent perceptions and recommendations. Child Adolesc Ment Health 2023; 28:124-127. [PMID: 36507594 DOI: 10.1111/camh.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
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 (Mage = 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.
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Ahmed A, Hassan A, Aziz S, Abd-Alrazaq AA, Ali N, Alzubaidi M, Al-Thani D, Elhusein B, Siddig MA, Ahmed M, Househ M. Chatbot features for anxiety and depression: A scoping review. Health Informatics J 2023; 29:14604582221146719. [PMID: 36693014 DOI: 10.1177/14604582221146719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chatbots can provide valuable support to patients in assessing and guiding management of various health problems particularly when human resources are scarce. Chatbots can be affordable and efficient on-demand virtual assistants for mental health conditions, including anxiety and depression. We review features of chatbots available for anxiety or depression. Six bibliographic databases were searched including backward and forwards reference list checking. The initial search returned 1302 citations. Post-filtering, 42 studies remained forming the final dataset for this scoping review. Most of the studies were from conference proceedings (62%, 26/42), followed by journal articles (26%, 11/42), reports (7%, 3/42), or book chapters (5%, 2/42). About half of the reviewed chatbots had functionality targeting both anxiety and depression (60%, 25/42), whereas 38% (16/42) targeted only depression, 38% (16/42) anxiety and the remaining addressed other mental health issues along with anxiety and depression. Avatars or fictional characters were rarely used in these studies only 26% (11/42) despite their increasing popularity. Mental health chatbots could benefit in helping patients with anxiety and depression and provide valuable support to mental healthcare workers, particularly when resources are scarce. Real-time personal virtual assistance fills in this gap. Their role in mental health care is expected to increase.
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Affiliation(s)
- Arfan Ahmed
- AI Center for Precision Health, 36579Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Asmaa Hassan
- College of Science and Engineering, 370593Hamad Bin Khalifa University, Doha, Qatar
| | - Sarah Aziz
- AI Center for Precision Health, 36579Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Alaa A Abd-Alrazaq
- AI Center for Precision Health, 36579Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Nashva Ali
- College of Science and Engineering, 370593Hamad Bin Khalifa University, Doha, Qatar
| | - Mahmood Alzubaidi
- College of Science and Engineering, 370593Hamad Bin Khalifa University, Doha, Qatar
| | - Dena Al-Thani
- College of Science and Engineering, 370593Hamad Bin Khalifa University, Doha, Qatar
| | - Bushra Elhusein
- Mental Health Services, 36977Hamad Medical Corporation, Doha, Qatar
| | | | - Maram Ahmed
- Mental Health Services, 36977Hamad Medical Corporation, Doha, Qatar
| | - Mowafa Househ
- College of Science and Engineering, 370593Hamad Bin Khalifa University, Doha, Qatar
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12
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Malloy J, Partridge SR, Kemper JA, Braakhuis A, Roy R. Co-design of digital health interventions with young people: A scoping review. Digit Health 2023; 9:20552076231219117. [PMID: 38107986 PMCID: PMC10722957 DOI: 10.1177/20552076231219117] [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: 07/12/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Innovative health promotion strategies are crucial for enhancing global quality of life and curbing premature deaths. Digital health promotion is particularly impactful for young individuals often using internet-connected devices. Collaborative methodologies in digital intervention research offer insights into supporting youth during key life stages, such as adolescence. This review sought to examine the literature on digital health interventions for youth co-designed via participatory frameworks. Methods Following the Joanna Briggs Institute Manual and an adapted Arksey & O'Malley's 6-stage framework, this review utilised the PRISMA-ScR checklist for structured reporting. Peer-reviewed research where young individuals (15-35 years) contributed to digital health intervention design was analysed. Systematic synthesis adhered to Braun & Clarke's Thematic Analysis Guidelines, mapping data to research queries and thematic framework. Results Eighteen articles were systematically synthesised, revealing seven main themes: digital tool, inquiry field, report aim, participatory activities, intervention attributes and behavioural change support. Seventeen distinctive digital health interventions were assessed, mostly within risk mitigation and mental health domains. Predominantly, interventions were web-based, with mental wellness websites emerging as the prevalent tool. User experience testing stood out as the primary reported outcome. Conclusion Several innovative digital health interventions targeting youth have been identified. Platforms including social media, specialised apps, websites and video games are instrumental for health advice and clinical support dissemination, overcoming access and cost barriers. Participatory techniques are integral for the efficacy of digital health resources, encompassing youth aspirations and anticipations. Continued efforts will enrich comprehension of optimal practices in digital health promotion and intervention formulation.
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Affiliation(s)
- Jessica Malloy
- Discipline of Nutrition & Dietetics, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Stephanie R Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Joya A Kemper
- Department of Management, Marketing, and Entrepreneurship, University of Canterbury Business School, University of Canterbury, Christchurch, New Zealand
| | - Andrea Braakhuis
- Discipline of Nutrition & Dietetics, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Discipline of Nutrition & Dietetics, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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13
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Shan Y, Ji M, Xie W, Qian X, Li R, Zhang X, Hao T. Language Use in Conversational Agent-Based Health Communication: Systematic Review. J Med Internet Res 2022; 24:e37403. [PMID: 35802407 PMCID: PMC9308072 DOI: 10.2196/37403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/11/2022] [Accepted: 06/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Given the growing significance of conversational agents (CAs), researchers have conducted a plethora of relevant studies on various technology- and usability-oriented issues. However, few investigations focus on language use in CA-based health communication to examine its influence on the user perception of CAs and their role in delivering health care services. Objective This review aims to present the language use of CAs in health care to identify the achievements made and breakthroughs to be realized to inform researchers and more specifically CA designers. Methods This review was conducted by following the protocols of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. We first designed the search strategy according to the research aim and then performed the keyword searches in PubMed and ProQuest databases for retrieving relevant publications (n=179). Subsequently, 3 researchers screened and reviewed the publications independently to select studies meeting the predefined selection criteria. Finally, we synthesized and analyzed the eligible articles (N=11) through thematic synthesis. Results Among the 11 included publications, 6 deal exclusively with the language use of the CAs studied, and the remaining 5 are only partly related to this topic. The language use of the CAs in these studies can be roughly classified into six themes: (1) personal pronouns, (2) responses to health and lifestyle prompts, (3) strategic wording and rich linguistic resources, (4) a 3-staged conversation framework, (5) human-like well-manipulated conversations, and (6) symbols and images coupled with phrases. These derived themes effectively engaged users in health communication. Meanwhile, we identified substantial room for improvement based on the inconsistent responses of some CAs and their inability to present large volumes of information on safety-critical health and lifestyle prompts. Conclusions This is the first systematic review of language use in CA-based health communication. The results and limitations identified in the 11 included papers can give fresh insights into the design and development, popularization, and research of CA applications. This review can provide practical implications for incorporating positive language use into the design of health CAs and improving their effective language output in health communication. In this way, upgraded CAs will be more capable of handling various health problems particularly in the context of nationwide and even worldwide public health crises.
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Affiliation(s)
- Yi Shan
- School of Foreign Studies, Nantong University, Nantong, China
| | - Meng Ji
- School of Languages and Cultures, University of Sydney, Sydney, Australia
| | - Wenxiu Xie
- Department of Computer Science, City University of Hong Kong, Hong Kong, China
| | - Xiaobo Qian
- School of Computer Science, South China Normal University, Guangzhou, China
| | - Rongying Li
- School of Artificial Intelligence, South China Normal University, Guangzhou, China
| | - Xiaomin Zhang
- Department of Linguistics, Macquarie University, Sydney, Australia
| | - Tianyong Hao
- School of Computer Science, South China Normal University, Guangzhou, China
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14
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Pernencar C, Saboia I, Dias JC. How Far Can Conversational Agents Contribute to IBD Patient Health Care—A Review of the Literature. Front Public Health 2022; 10:862432. [PMID: 35844879 PMCID: PMC9282671 DOI: 10.3389/fpubh.2022.862432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Modern societies are facing health and healthcare challenges as never seen before. The digital world in which we are living today considers digital health interventions such as “internet-delivered” therapy (e-Therapy) or mobile apps as an integrated part of healthcare systems. Digital transformation in health care requires the active involvement of patients as the central part of healthcare interventions. In the case of chronic health conditions, such as inflammatory bowel disease (IBD), it is believed that the adoption of new digital tools helps to maintain and extend the health and care of patients, optimizing the course of the treatment of the disease. The study goal was to undertake a literature review associating the use of chatbot technology with IBD patients' health care. This study intends to support digital product developments, mainly chatbot for IBD or other chronic diseases. The work was carried out through two literature review phases. The first one was based on a systematic approach and the second was a scoping review focused only on Frontiers Journals. This review followed a planned protocol for search and selection strategy that was created by a research team discussion. Chatbot technology for chronic disease self-management can have high acceptance and usability levels. The more interaction with a chatbot, the more patients are able to increase their self-care practice, but there is a challenge. The chatbot ontology to personalize the communication still needed to have strong guidelines helping other researchers to define which Electronic Medical Records (EMRs) should be used in the chatbots to improve the user satisfaction, engagement, and dialog quality. The literature review showed us both evidence and success of these tools in other health disorders. Some of them revealed a huge potential for conversational agents as a part of digital health interventions.
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Affiliation(s)
- Cláudia Pernencar
- ICNOVA—NOVA Institute of Communication, NOVA School of Social Sciences and Humanities, Universidade NOVA de Lisboa, Lisbon, Portugal
- LIDA—Arts and Design Research Lab, Polytechnic Institute of Leiria, Leiria, Portugal
- *Correspondence: Cláudia Pernencar
| | - Inga Saboia
- UFC Virtual, Federal University of Ceará, Fortaleza, Brazil
- DigiMedia—Department of Communication and Art, University of Aveiro, Aveiro, Portugal
| | - Joana Carmo Dias
- COMEGI—Research Center on Organizations, Markets and Industrial Management, Lisbon, Portugal
- UNIDCOM/IADE—Design and Communication Research Centre, Lisbon, Portugal
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Tsoi EWS, Mak WWS, Ho CYY, Yeung GTY. TourHeart—An Online Stratified Stepped Care Mental Health Platform: Qualitative Evaluation from Multiple Stakeholders’ Perspectives (Preprint). JMIR Hum Factors 2021; 9:e35057. [PMID: 35560109 PMCID: PMC9143776 DOI: 10.2196/35057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background TourHeart, a web-based stratified stepped care mental health platform, is a one-stop solution that integrates psychoeducation and other well-being promotional tools for mental health promotion and mental illness prevention and evidence-based, low-intensity psychological interventions for the treatment of people with anxiety and depressive symptoms. Instead of focusing only on symptom reduction, the platform aims to be person-centered and recovery-oriented, and continual feedback from stakeholders is sought. Understanding the perspectives of users and service providers enables platform developers to fine-tune both the design and content of the services for enhanced service personalization and personal recovery. Objective This qualitative study evaluated a web-based mental health platform by incorporating the perspectives of both users and service providers who administered the platform and provided coaching services. The platform included both web-based and offline services targeting adults along the mental health spectrum based on the two-continua model of mental health and mental illness. Methods Interview questions were designed based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM). Views on offline services, the design of the web-based platform, user experience, and the contents of the platform were explored using semistructured interviews. A total of 27 service users and 22 service providers were recruited using purposive criterion sampling. A hybrid thematic analysis was performed to identify salient aspects of users’ and providers’ experiences with and views of the platform. Results Totally, 3 broad themes (namely, the quality of the platform, drivers for platform use, and coaching services) emerged from the interview data that highlighted users’ views of and experiences with the web-based platform. The platform’s general esthetics, operations, and contents were found to be critical features and drivers for continued use. Although coaching services were indispensable, participants preferred the autonomy and anonymity associated with web-based mental health services. Conclusions This study highlights the importance of web-based mental health services being easy to navigate and understand, being user-centric, and providing adequate guidance in self-help. It also confirms existing design standards and recommendations and suggests that more rigorous, iterative user experience research and robust evaluation should be conducted in the future adaptation of web-based stratified stepped care services, so that they can be more personalized and better promote personal recovery.
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Affiliation(s)
- Emily W S Tsoi
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Connie Y Y Ho
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Gladys T Y Yeung
- New Life Psychiatric Rehabilitation Association, Kowloon, China (Hong Kong)
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Potts C, Ennis E, Bond RB, Mulvenna MD, McTear MF, Boyd K, Broderick T, Malcolm M, Kuosmanen L, Nieminen H, Vartiainen AK, Kostenius C, Cahill B, Vakaloudis A, McConvey G, O’Neill S. Chatbots to Support Mental Wellbeing of People Living in Rural Areas: Can User Groups Contribute to Co-design? JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 6:652-665. [PMID: 34568548 PMCID: PMC8450556 DOI: 10.1007/s41347-021-00222-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/22/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Digital technologies such as chatbots can be used in the field of mental health. In particular, chatbots can be used to support citizens living in sparsely populated areas who face problems such as poor access to mental health services, lack of 24/7 support, barriers to engagement, lack of age appropriate support and reductions in health budgets. The aim of this study was to establish if user groups can design content for a chatbot to support the mental wellbeing of individuals in rural areas. University students and staff, mental health professionals and mental health service users (N = 78 total) were recruited to workshops across Northern Ireland, Ireland, Scotland, Finland and Sweden. The findings revealed that participants wanted a positive chatbot that was able to listen, support, inform and build a rapport with users. Gamification could be used within the chatbot to increase user engagement and retention. Content within the chatbot could include validated mental health scales and appropriate response triggers, such as signposting to external resources should the user disclose potentially harmful information or suicidal intent. Overall, the workshop participants identified user needs which can be transformed into chatbot requirements. Responsible design of mental healthcare chatbots should consider what users want or need, but also what chatbot features artificial intelligence can competently facilitate and which features mental health professionals would endorse.
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Affiliation(s)
- C. Potts
- School of Computing, Ulster University, Newtownabbey, UK
| | - E. Ennis
- School of Psychology, Ulster University, Derry-Londonderry, UK
| | - R. B. Bond
- School of Computing, Ulster University, Newtownabbey, UK
| | - M. D. Mulvenna
- School of Computing, Ulster University, Newtownabbey, UK
| | - M. F. McTear
- School of Computing, Ulster University, Newtownabbey, UK
| | - K. Boyd
- School of Art, Ulster University, Belfast, UK
| | - T. Broderick
- Department of Sport, Leisure and Childhood Studies, Munster Technological University, Cork, Ireland
| | | | - L. Kuosmanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - H. Nieminen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - A. K. Vartiainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - C. Kostenius
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - B. Cahill
- Nimbus Research Centre, Munster Technological University, Cork, Ireland
| | - A. Vakaloudis
- Nimbus Research Centre, Munster Technological University, Cork, Ireland
| | | | - S. O’Neill
- School of Psychology, Ulster University, Derry-Londonderry, UK
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