Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Aug 9:25:e46761.
doi: 10.2196/46761.

Chatbots to Improve Sexual and Reproductive Health: Realist Synthesis

Rhiana Mills #  1 , Emily Rose Mangone #  2 , Neal Lesh #  3 , Diwakar Mohan #  4 , Paula Baraitser #  1
Affiliations
Review

Chatbots to Improve Sexual and Reproductive Health: Realist Synthesis

Rhiana Mills et al. J Med Internet Res. .

Abstract

Background: Digital technologies may improve sexual and reproductive health (SRH) across diverse settings. Chatbots are computer programs designed to simulate human conversation, and there is a growing interest in the potential for chatbots to provide responsive and accurate information, counseling, linkages to products and services, or a companion on an SRH journey.

Objective: This review aimed to identify assumptions about the value of chatbots for SRH and collate the evidence to support them.

Methods: We used a realist approach that starts with an initial program theory and generates causal explanations in the form of context, mechanism, and outcome configurations to test and develop that theory. We generated our program theory, drawing on the expertise of the research team, and then searched the literature to add depth and develop this theory with evidence.

Results: The evidence supports our program theory, which suggests that chatbots are a promising intervention for SRH information and service delivery. This is because chatbots offer anonymous and nonjudgmental interactions that encourage disclosure of personal information, provide complex information in a responsive and conversational tone that increases understanding, link to SRH conversations within web-based and offline social networks, provide immediate support or service provision 24/7 by automating some tasks, and provide the potential to develop long-term relationships with users who return over time. However, chatbots may be less valuable where people find any conversation about SRH (even with a chatbot) stigmatizing, for those who lack confidential access to digital devices, where conversations do not feel natural, and where chatbots are developed as stand-alone interventions without reference to service contexts.

Conclusions: Chatbots in SRH could be developed further to automate simple tasks and support service delivery. They should prioritize achieving an authentic conversational tone, which could be developed to facilitate content sharing in social networks, should support long-term relationship building with their users, and should be integrated into wider service networks.

Keywords: artificial intelligence; chatbot; counseling; development; device; digital device; disclosure; realist synthesis; reproductive; service networks; sexual; sexual and reproductive health; social media; social networks; theory; treatment.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: ERM is a program officer on the Family Planning team at the Bill & Melinda Gates Foundation. She developed the scope of work for this research. As program officer, she contributed technical input but did not directly conduct the study. NL is the Chief Strategy Officer at Dimagi, a social enterprise organization. Dimagi builds and provides behavior-change chatbots to organizations, including for SRH.

Figures

Figure 1
Figure 1
Initial program theory. CDC: Centers for Disease Control and Prevention; SRH: sexual and reproductive health.
Figure 2
Figure 2
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram for new systematic reviews, which included searches of databases and other sources (adapted from Page et al [26]). SRH: sexual and reproductive health.
Figure 3
Figure 3
Final program theory. AI: artificial intelligence; SRH: sexual and reproductive health.
See this image and copyright information in PMC

References

    1. Adamopoulou E, Moussiades L. An overview of chatbot technology. In: Maglogiannis I, Iliadis L, Pimenidis E, editors. Artificial Intelligence Applications and Innovations. AIAI 2020. IFIP Advances in Information and Communication Technology, vol 584. Cham: Springer; 2020. pp. 373–383.
    1. Knight C. Chatbots augmenting/replacing more internal business tasks in 2019. Medium. 2019. [2023-06-15]. https://chrisknightcms.medium.com/chatbots-augmenting-replacing-more-int... .
    1. Curtis RG, Bartel B, Ferguson T, Blake HT, Northcott C, Virgara R, Maher CA. Improving user experience of virtual health assistants: scoping review. J Med Internet Res. 2021;23(12):e31737. doi: 10.2196/31737. https://www.jmir.org/2021/12/e31737/ v23i12e31737 - DOI - PMC - PubMed
    1. Ly KH, Ly AM, Andersson G. A fully automated conversational agent for promoting mental well-being: a pilot RCT using mixed methods. Internet Interv. 2017;10:39–46. doi: 10.1016/j.invent.2017.10.002. https://linkinghub.elsevier.com/retrieve/pii/S2214-7829(17)30091-X S2214-7829(17)30091-X - DOI - PMC - PubMed
    1. Fitzpatrick KK, Darcy A, Vierhile M. Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR Ment Health. 2017;4(2):e19. doi: 10.2196/mental.7785. https://mental.jmir.org/2017/2/e19/ v4i2e19 - DOI - PMC - PubMed

Publication types