{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T05:19:49Z","timestamp":1793251189381,"version":"4.5.0"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Health care systems are increasingly considering large language model (LLM)\u2013based chatbots for vaccine communication, but evidence that they improve durable, behaviorally relevant outcomes beyond existing health materials is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine whether brief, multiturn interactions with an LLM chatbot increase parental intention to vaccinate children against human papillomavirus (HPV) compared with no intervention and government public health materials and to assess whether any effects persist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This randomized clinical trial was conducted online among individuals in the US, Canada, and the UK from March 3 to May 25, 2025, with follow-up at 15 and 45 days. Eligible participants were parents 18 years or older with at least 1 HPV vaccine\u2013eligible child (aged 11-17 years in the US and Canada and 12-17 years in the UK) who had not received HPV vaccination or whose vaccination status was unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Participants were randomized to (1) no-message control, (2) government public health materials matched to country (minimum 3-minute exposure), or (3) a 3-minute interaction with an LLM chatbot (OpenAI\u2019s GPT-4o) prompted to encourage HPV vaccination using a default response style or a shorter conversational style.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome was self-reported likelihood of vaccinating the child against HPV within 12 months (0- to 100-point scale, with 0 indicating extremely unlikely and 100 indicating extremely likely) measured immediately after intervention. Prespecified follow-ups included vaccination intent and self-reported vaccination at 15 and 45 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1297 participants (mean [SD] age, 42.84 [6.93] years; 935 [72.1%] female) were randomized. Compared with no intervention, public health materials increased immediate vaccination intent (Cohen\n                      <jats:italic>d<\/jats:italic>\n                      = 0.53; 95% CI, 0.36-0.70), as did the default chatbot (\n                      <jats:italic>d<\/jats:italic>\n                      = 0.48; 95% CI, 0.30-0.65) and conversational chatbot (\n                      <jats:italic>d<\/jats:italic>\n                      = 0.33; 95% CI, 0.17-0.49). At 45 days, neither chatbot increased intent relative to controls, whereas public health materials maintained modest effects. No intervention increased self-reported vaccination uptake.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The findings of this randomized clinical trial suggest that well-designed public health messaging may match or exceed the impact of short chatbot conversations for HPV vaccine promotion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT07132125\">NCT07132125<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.16822","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T15:30:39Z","timestamp":1780932639000},"page":"e2616822","source":"Crossref","is-referenced-by-count":4,"title":["Large Language Model Chatbot Conversations vs Public Health Materials and Parental HPV Vaccination Intentions"],"prefix":"10.1001","volume":"9","author":[{"given":"Neil K. R.","family":"Sehgal","sequence":"first","affiliation":[{"name":"Computer and Information Science Department, University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny","family":"Rai","sequence":"additional","affiliation":[{"name":"Computer and Information Science Department, University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Tonneau","sequence":"additional","affiliation":[{"name":"Oxford Internet Institute, University of Oxford, Oxford, UK"},{"name":"Development Impact Department, World Bank, Washington, DC"},{"name":"Department of Computer Science, New York University, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anish K.","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Penn Medicine Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia"},{"name":"Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Cappella","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Annenberg School for Communication, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie L.","family":"Kornides","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyle","family":"Ungar","sequence":"additional","affiliation":[{"name":"Computer and Information Science Department, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Buttenheim","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia"},{"name":"Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharath Chandra","family":"Guntuku","sequence":"additional","affiliation":[{"name":"Computer and Information Science Department, University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Annenberg School for Communication, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"zoi260475r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2025.103290","author":"Han","year":"2025","journal-title":"EClinMed"},{"issue":"33","key":"zoi260475r3","doi-asserted-by":"publisher","first-page":"708","DOI":"10.15585\/mmwr.mm7333a1","article-title":"National vaccination coverage among adolescents aged 13-17 years - National Immunization Survey-Teen, United States, 2023.","volume":"73","author":"Pingali","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"4","key":"zoi260475r4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013430.pub2","article-title":"Factors that influence caregivers\u2019 and adolescents\u2019 views and practices regarding human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis.","volume":"4","author":"Cooper","year":"2025","journal-title":"Cochrane Database Syst Rev"},{"key":"zoi260475r5","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-024-03538-1","article-title":"Influences of HPV disease perceptions, vaccine accessibility, and information exposure on social media on HPV vaccination uptake among 11,678 mothers with daughters aged 9-17 years in China: a cross-sectional study.","author":"Lin","year":"2024","journal-title":"BMC Med"},{"key":"zoi260475r6","doi-asserted-by":"publisher","DOI":"10.64628\/AAJ.akjf7gmka","article-title":"Vaccines and motherhood: are AI-generated health messages working in Kenya and Nigeria?.","author":"Addie","year":"2025","journal-title":"The Conversation"},{"issue":"9","key":"zoi260475r7","first-page":"1","article-title":"Public health communicators finding promise in AI tools.","volume":"55","author":"Nicolaus","year":"2025","journal-title":"Nations Health"},{"key":"zoi260475r9","doi-asserted-by":"crossref","DOI":"10.1126\/science.adq1814","article-title":"Durably reducing conspiracy beliefs through dialogues with AI.","author":"Costello","year":"2024","journal-title":"Science"},{"issue":"24","key":"zoi260475r10","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2403116121","article-title":"Evaluating the persuasive influence of political microtargeting with large language models.","volume":"121","author":"Hackenburg","year":"2024","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"2","key":"zoi260475r11","doi-asserted-by":"publisher","DOI":"10.1093\/pnasnexus\/pgae034","article-title":"How persuasive is AI-generated propaganda?","volume":"3","author":"Goldstein","year":"2024","journal-title":"Proc Natl Acad Sci U S A Nexus"},{"issue":"10","key":"zoi260475r14","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2413443122","article-title":"Scaling language model size yields diminishing returns for single-message political persuasion.","volume":"122","author":"Hackenburg","year":"2025","journal-title":"Proc Natl Acad Sci U S A"},{"key":"zoi260475r15","author":"Karinshak","year":"2023","journal-title":"Proc ACM Hum Comput Interact"},{"issue":"6777","key":"zoi260475r16","doi-asserted-by":"publisher","DOI":"10.1126\/science.aea3884","article-title":"The levers of political persuasion with conversational artificial intelligence.","volume":"390","author":"Hackenburg","year":"2025","journal-title":"Science"},{"issue":"11","key":"zoi260475r20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.44821","article-title":"Chatbot-delivered real-time support to improve HIV self-testing rates: a randomized clinical trial.","volume":"8","author":"Chen","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"10","key":"zoi260475r21","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.35813","article-title":"A hybrid chatbot to promote pneumococcal vaccination among older adults: a randomized clinical trial.","volume":"8","author":"Wang","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"25","key":"zoi260475r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2024.07.040","article-title":"Parental hesitancy about COVID-19, influenza, HPV, and other childhood vaccines.","volume":"42","author":"Santibanez","year":"2024","journal-title":"Vaccine"},{"key":"zoi260475r24","doi-asserted-by":"publisher","author":"Oladejo","journal-title":"Vaccine","DOI":"10.1016\/j.vaccine.2016.08.046"},{"issue":"9","key":"zoi260475r25","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.24502","article-title":"Trends in human papillomavirus vaccine safety concerns and adverse event reporting in the United States.","volume":"4","author":"Sonawane","year":"2021","journal-title":"JAMA Netw Open"},{"key":"zoi260475r29","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.chb.2018.03.051","article-title":"Living up to the chatbot hype: the influence of anthropomorphic design cues and communicative agency framing on conversational agent and company perceptions.","volume":"85","author":"Araujo","year":"2018","journal-title":"Comput Human Behav"},{"issue":"6","key":"zoi260475r31","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1038\/s41591-025-03618-6","article-title":"A vaccine chatbot intervention for parents to improve HPV vaccination uptake among middle school girls: a cluster randomized trial.","volume":"31","author":"Hou","year":"2025","journal-title":"Nat Med"},{"issue":"9","key":"zoi260475r32","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1038\/s41562-024-01940-6","article-title":"A systematic review and meta-analysis of strategies to promote vaccination uptake.","volume":"8","author":"Liu","year":"2024","journal-title":"Nat Hum Behav"},{"key":"zoi260475r30","author":"Liebrecht","year":"2020"},{"key":"zoi260475r1","unstructured":"Centers for Disease Control. Reasons to Get Vaccinated. Human Papillomavirus (HPV) 2024. https:\/\/www.cdc.gov\/hpv\/vaccines\/reasons-to-get.html Accessed April 14, 2025."},{"key":"zoi260475r8","doi-asserted-by":"crossref","unstructured":"Czarnek? G, Orchinik? R, Lin? H, . Addressing climate change skepticism and inaction using human-AI dialogues. PsyArXiv. Preprint posted online April14, 2025. https:\/\/osf.io\/preprints\/psyarxiv\/mqcwj_v1","DOI":"10.31234\/osf.io\/mqcwj_v1"},{"key":"zoi260475r12","doi-asserted-by":"crossref","unstructured":"Costello? TH, Pennycook? G, Rand? D. Just the facts: how dialogues with AI reduce conspiracy beliefs. PsyArXiv. Preprint posted online April 14, 2025.","DOI":"10.31234\/osf.io\/h7n8u_v2"},{"key":"zoi260475r13","doi-asserted-by":"crossref","unstructured":"Salvi? F, Ribeiro? MH, Gallotti? R, West? R. On the conversational persuasiveness of large language models: a randomized controlled trial.? arXiv. Preprint posted online April 14, 2025. doi:10.21203\/rs.3.rs-4429707\/v1","DOI":"10.21203\/rs.3.rs-4429707\/v1"},{"key":"zoi260475r17","doi-asserted-by":"crossref","unstructured":"Crabtree? C, Holbein? J, Bosley? M, Sevi? S. Can AI help reduce prejudice? evaluating the effectiveness of AI-powered personalized persuasion on support for transgender rights. Accessed April 24, 2025. https:\/\/ssrn.com\/abstract=5229084","DOI":"10.2139\/ssrn.5229084"},{"key":"zoi260475r18","unstructured":"Sehgal? NK, Tonneau? M, Tan? A, . Effect of static vs. conversational ai-generated messages on colorectal cancer screening intent: a randomized controlled trial.? arXiv. Preprint posted online July 10, 2025."},{"key":"zoi260475r19","unstructured":"Xu? HG, . Personalized dialogues with AI effectively address parents\u2019 concerns about HPV vaccination.? PsyArXiv. Preprint posted online April 14, 2025."},{"key":"zoi260475r23","doi-asserted-by":"crossref","unstructured":"Stagnaro? MN, Druckman? J, Berinsky? AJ, . Representativeness versus response quality: assessing nine opt-in online survey samples.? PsyArXiv. Preprint posted online April 14, 2025.","DOI":"10.31234\/osf.io\/h9j2d_v2"},{"key":"zoi260475r26","unstructured":"Centers for Disease Control and Prevention. Impact of the HPV Vaccine. Human Papillomavirus (HPV). Accessed April 14, 2025. https:\/\/www.cdc.gov\/hpv\/vaccination-impact\/index.html?"},{"key":"zoi260475r27","unstructured":"National Health Service. HPV vaccine. 2024. Accessed April 14, 2025. https:\/\/www.nhs.uk\/vaccinations\/hpv-vaccine\/"},{"key":"zoi260475r28","unstructured":"Government of Canada. Human papillomavirus (HPV): spread, prevention and risks. 2025. Accessed April 14, 2025. https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/human-papillomavirus-hpv\/spread-prevention-risks.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2849959\/sehgal_2026_oi_260475_1780084504.51504.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T15:30:48Z","timestamp":1780932648000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2849959"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":32,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.16822","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]}}}