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. 2020 Aug 7;22(8):e17158.
doi: 10.2196/17158.

Conversational Agents in Health Care: Scoping Review and Conceptual Analysis

Lorainne Tudor Car  1   2 , Dhakshenya Ardhithy Dhinagaran  1 , Bhone Myint Kyaw  1 , Tobias Kowatsch  3   4   5 , Shafiq Joty  6 , Yin-Leng Theng  7 , Rifat Atun  8
Affiliations

Conversational Agents in Health Care: Scoping Review and Conceptual Analysis

Lorainne Tudor Car et al. J Med Internet Res. .

Abstract

Background: Conversational agents, also known as chatbots, are computer programs designed to simulate human text or verbal conversations. They are increasingly used in a range of fields, including health care. By enabling better accessibility, personalization, and efficiency, conversational agents have the potential to improve patient care.

Objective: This study aimed to review the current applications, gaps, and challenges in the literature on conversational agents in health care and provide recommendations for their future research, design, and application.

Methods: We performed a scoping review. A broad literature search was performed in MEDLINE (Medical Literature Analysis and Retrieval System Online; Ovid), EMBASE (Excerpta Medica database; Ovid), PubMed, Scopus, and Cochrane Central with the search terms "conversational agents," "conversational AI," "chatbots," and associated synonyms. We also searched the gray literature using sources such as the OCLC (Online Computer Library Center) WorldCat database and ResearchGate in April 2019. Reference lists of relevant articles were checked for further articles. Screening and data extraction were performed in parallel by 2 reviewers. The included evidence was analyzed narratively by employing the principles of thematic analysis.

Results: The literature search yielded 47 study reports (45 articles and 2 ongoing clinical trials) that matched the inclusion criteria. The identified conversational agents were largely delivered via smartphone apps (n=23) and used free text only as the main input (n=19) and output (n=30) modality. Case studies describing chatbot development (n=18) were the most prevalent, and only 11 randomized controlled trials were identified. The 3 most commonly reported conversational agent applications in the literature were treatment and monitoring, health care service support, and patient education.

Conclusions: The literature on conversational agents in health care is largely descriptive and aimed at treatment and monitoring and health service support. It mostly reports on text-based, artificial intelligence-driven, and smartphone app-delivered conversational agents. There is an urgent need for a robust evaluation of diverse health care conversational agents' formats, focusing on their acceptability, safety, and effectiveness.

Keywords: artificial intelligence; chatbots; conversational agents; health care; machine learning; mobile phone; scoping review.

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Conflict of interest statement

Conflicts of Interest: TK is affiliated with the Center for Digital Health Interventions, a joint initiative of the Department of Management, Technology, and Economics at ETH Zurich and the Institute of Technology Management at the University of St. Gallen, which is funded in part by the Swiss health insurer CSS. TK is also a cofounder of Pathmate Technologies, a university spin-off company that creates and delivers digital clinical pathways. Other authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Evolution of conversational agents from 1966 to 2019.
Figure 2
Figure 2
PRISMA flow chart.
Figure 3
Figure 3
Bubble plots showing the distribution of identified study designs, types of conversational agents and healthcare topics in the included articles, plotted against the year of the publication. The scale on the right indicates that the size of the bubble is associated with the number of studies whereby the smallest denotes 1 study and the largest, 10 studies.
See this image and copyright information in PMC

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