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
. 2025 Apr 28:11:20552076251337321.
doi: 10.1177/20552076251337321. eCollection 2025 Jan-Dec.

Patient-facing chatbots: Enhancing healthcare accessibility while navigating digital literacy challenges and isolation risks-a mixed-methods study

Annie A Moore  1 , Jessica R Ellis  2 , Natalia Dellavalle  2 , Marlee Akerson  2   3 , Matt Andazola  4 , Eric G Campbell  2 , Matthew DeCamp  1   2
Affiliations

Patient-facing chatbots: Enhancing healthcare accessibility while navigating digital literacy challenges and isolation risks-a mixed-methods study

Annie A Moore et al. Digit Health. .

Abstract

Objective: Digital communication between patients and healthcare teams is increasing. Most patients find this effective, yet many patients remain digitally isolated, a social determinant of health. This study investigates patient attitudes toward healthcare's newest digital assistant, the chatbot, and perceptions regarding healthcare access.

Methods: We conducted a mixed methods study among patient users of a large healthcare system's chatbot integrated within an electronic health record. We purposively oversampled by race and ethnicity to survey 617/3089 (response rate 20%) patient users online using de novo and validated items. In addition, we conducted semi-structured interviews with users (n = 46) purposively sampled based on diversity, age, or select survey responses between November 2022 and May 2024.

Results: In surveys, 213/609 (35.0%) felt they could not understand the chatbot completely, and 376/614 (61.2%) felt the chatbot did not completely understand them. Of 238 users who felt completely understood by the chatbot, 178 (74.8%) believed the chatbot was intended to help them access healthcare; in comparison, of 376 users who felt not completely understood, 155 (41%) believed the chatbot was intended to help access (p < 0.001). In interviews, among themes observed, Black, Hispanic, less educated, younger, and lower-income participants expressed more positivity about the chatbot aiding healthcare access, stating convenience and perceived absence of judgment or bias.

Conclusion: Patients' experience with the chatbot appears to affect their perception of the intent of the chatbot's implementation; those adept at chatbot communication or within historically less trusting groups may prefer a quick, non-judgmental answer to questions via the chatbot rather than human interaction. Although our findings are limited to one health system's existing chatbot users, as patient-facing chatbots expand, attention to these factors can support healthcare systems' efforts to design chatbots that meet the unique communication needs of all patients, expressly those at risk of digital isolation.

Keywords: Patient-facing chatbots; digital isolation; digital literacy; healthcare access; patient experience.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Interviewee participants responses to does the chatbot improve healthcare access.
Figure 2.
Figure 2.
Optimal system, chatbot and patient factors to promote chatbot user benefits and those excluded.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Nath B, Williams B, Jeffery MM, et al. Trends in electronic health record inbox messaging during the COVID-19 pandemic in an ambulatory practice network in New England. JAMA Netw Open 2021; 4: e2131490. PubMed PMID: 34636917; PubMed Central PMCID: PMC8511977. - PMC - PubMed
    1. North F, Luhman KE, Mallmann EA, et al. A retrospective analysis of provider-to-patient secure messages: how much are they increasing, who is doing the work, and is the work happening after hours? JMIR Med Inform 2020; 8: e16521. PubMed PMID: 32673238; PubMed Central PMCID: PMC7381047. - PMC - PubMed
    1. Wetsman N. Digital messages from patients to doctors spiked during the pandemic. The Verge2021 [12.11.2021]. September 17, 2021: https://www.theverge.com/2021/9/17/22679239/patient-messages-health-reco....
    1. Hegeman P, Vader D, Kamke Ket al. et al. Patterns of digital health access and use among US adults: a latent class analysis. Res Sq 2024 [Preprint]. 2024 Jan 29.rs.3.rs-3895228. doi: 10.21203/rs.3.rs-3895228/v1. Update in: BMC Digit Health. 2024(2):42: doe: 10.1186/s44247-024-00100-0. PubMed PMID: 38352382; PubMed Central PMCID: PMC10862941. - PMC - PubMed
    1. Benda NC, Veinot TC, Sieck CJet al. et al. Broadband internet access is a social determinant of health!. Am J Public Health 2020; 110: 1123–1125. PubMed PMID: 32639914; PubMed Central PMCID: PMC7349425. - PMC - PubMed

LinkOut - more resources