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More advanced, responsive, and tailored digital interventions using machine learning and artificial intelligence may be a valuable tool for successful smoking cessation referrals.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study used the dynamic systems development method to incorporate patient and consumer sources of conversational data to develop a technology-assisted motivational interviewing (TAMI) chatbot, a digital agent using machine learning models to deliver motivational interviewing (MI) for tobacco cessation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n During the functional model iteration phase, user-centered design interviews with smokers (n=3) informed the creation of TAMI. The design and build phase involved the use of existing datasets to guide the incorporation of MI-consistent utterances, language recognition, and topic classification to guide a discussion about smoking, and providing a tailored quit plan if indicated. During the implementation phase, user experience interviews with randomly selected participants (n=9) in a pilot trial discussed their experiences with TAMI.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n User-centered design interviews indicated a desire for a chatbot that was engaging and adaptable to personal interests in quitting smoking. Inductive analysis of user experience interviews revealed that anonymity, regular reminders, and a humanized experience facilitated engagement with TAMI, but technical glitches, chatbot misunderstandings, and issues with rapport were barriers to engagement.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Informed by user input and patient and consumer datasets, TAMI can use MI skills to elicit change talk and\/or accurately evaluate readiness for tobacco cessation. Further development will enhance TAMI\u2019s ability to seamlessly engage with users when discussing behavior change and assist underserved populations achieve improvements in a variety of health behavior goals.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/88125","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T19:05:07Z","timestamp":1776971107000},"page":"e88125-e88125","source":"Crossref","is-referenced-by-count":1,"title":["Use of the Dynamic Systems Development Method to Inform Technology-Assisted Motivational Interviewing (TAMI) for Tobacco Cessation: Qualitative Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1491-7771","authenticated-orcid":false,"given":"Brian","family":"Borsari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3219-5503","authenticated-orcid":false,"given":"Joannalyn","family":"Delacruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7448-9955","authenticated-orcid":false,"given":"Ahson","family":"Saiyed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0369-3247","authenticated-orcid":false,"given":"John","family":"Layton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0005-7299","authenticated-orcid":false,"given":"Karla D","family":"Llanes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0290-8974","authenticated-orcid":false,"given":"Isaac A","family":"Mirzadegan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0417-3713","authenticated-orcid":false,"given":"Jing","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9717-5282","authenticated-orcid":false,"given":"Anita S","family":"Hargrave-Bouagnon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5752-767X","authenticated-orcid":false,"given":"Meredith C","family":"Meacham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7270-8732","authenticated-orcid":false,"given":"Delwyn","family":"Catley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2765-3701","authenticated-orcid":false,"given":"Jason","family":"Satterfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"issue":"18","key":"R1","doi-asserted-by":"publisher","first-page":"475","DOI":"10.15585\/mmwr.mm7218a1","article-title":"Tobacco product use among adults\u2014United States, 2021","volume":"72","author":"Cornelius","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"R2","unstructured":"Tobacco. 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