The advent of such technology has created a novel way to improve person-centered healthcare. Healthbots are computer programs that mimic conversation with users using text or spoken language 9. To facilitate two-way health communication and center care around the individual user, apps are integrating conversational agents or “healthbots” within the app 7, 8. Concurrently, there has also been a proliferation of health-related apps, with an estimated 318,000 health apps available globally in 2017 6. A 2017 study in Sub-Saharan Africa, reported that 41% of Internet users used the Internet for health information and medicine 5, highlighting the value of the internet as a global health information source. In the U.S., over 70% of the population uses the Internet as a source of health information 4. Over the last decade, the internet and the use of health apps have emerged as critical spaces where individuals are accessing health information. Integrated person-centered health services require that individuals be empowered to take charge of their own health, and have the education and support they need to make informed health decisions 3. In recent years, there has been a paradigm shift in recognizing the need to structure health services, so they are organized around the individuals seeking care, rather than on the disease 1, 2. Healthbots are potentially transformative in centering care around the user however, they are in a nascent state of development and require further research on development, automation and adoption for a population-level health impact. Most apps allowed for a finite-state input, where the dialogue is led by the system and follows a predetermined algorithm. Our assessment indicated that only a few apps use machine learning and natural language processing approaches, despite such marketing claims. Most of the 78 apps reviewed focus on primary care and mental health, only 6 (7.59%) had a theoretical underpinning, and 10 (12.35%) complied with health information privacy regulations. Most healthbots are patient-facing, available on a mobile interface and provide a range of functions including health education and counselling support, assessment of symptoms, and assistance with tasks such as scheduling. The review suggests uptake across 33 low- and high-income countries. Apps were assessed using an evaluation framework addressing chatbot characteristics and natural language processing features. Apps were identified using 42Matters software, a mobile app search engine. Eligible apps were those that were health-related, had an embedded text-based conversational agent, available in English, and were available for free download through the Google Play or Apple iOS store. Our review of healthbots aims to classify types of healthbots, contexts of use, and their natural language processing capabilities. There is limited evidence on how such healthbots are developed and applied in practice. Health-focused apps with chatbots (“healthbots”) have a critical role in addressing gaps in quality healthcare.
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