{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:58:56Z","timestamp":1789739936101,"version":"4.0.1"},"reference-count":66,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Hum Factors"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Body image dissatisfaction, disordered eating, and eating disorders represent significant public health concerns; however, many affected individuals never access evidence-based support. We co-designed and developed a rule-based chatbot, JEM, which conducts conversations addressing evidence-based psychoeducation and psychotherapeutic microinterventions. We previously demonstrated the feasibility, acceptability, and preliminary satisfaction of the JEM chatbot in a research setting. However, broader satisfaction, experiences, and user-reported outcomes in real-world settings have not yet been investigated.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to conduct a real-world evaluation of the JEM chatbot in Australia and Canada, the two countries that have hosted a deployment of the chatbot to date. Specifically, we aim to explore user satisfaction and experiences with the chatbot and within-session differences in user mood and body image satisfaction when completing the chatbot\u2019s microinterventions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Respondents were users of the JEM chatbot aged 13 to 64 years who self-selected to complete a web-based overall evaluation survey (N=230; n=122 in Australia and n=108 in Canada) over a 6-month period. This evaluation survey included user demographic characteristics, satisfaction measures, and the System Usability Scale. Respondents for the within-session pre-post analyses were JEM chatbot users who chose to complete brief web-based surveys immediately before and after completing one of the chatbot\u2019s microinterventions during the same 6-month period. Sample sizes varied across microinterventions, ranging from 75 to 276 respondents overall (Australia: n=34\u2010146; Canada: n=39\u2010130). These surveys included validated visual analog scales (VAS) measuring mood (anxiety, depression, happiness, confidence) and body image satisfaction (body size satisfaction, body shape satisfaction, physical attractiveness).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Demographic characteristics showed that survey respondents were commonly young adult cisgender women and nonbinary individuals across Australia and Canada. Respondent satisfaction with the chatbot was high in both countries (Australia: mean 76.1, SD 22.7; Canada: mean 78.8, SD 14.3), and the usability of the chatbot was rated as \u201cexcellent\u201d in both countries (Australia: mean 86.5, SD 16.9; Canada: mean 89.5, SD 11.6) according to the System Usability Scale. Across completed microintervention surveys, patterns of within-session pre-post ratings were broadly similar in Australia and Canada, with effect sizes generally ranging from very small to large across VAS-measured mood and body image outcomes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The JEM chatbot achieved high satisfaction and usability ratings. Among respondents who completed pre-post surveys, immediate within-session differences in mood and body image ratings were observed following the completion of chatbot microinterventions. The study findings were broadly similar across Australia and Canada. These results provide evidence of user experience and within-session differences following engagement with JEM and support continued evaluation in future studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/90783","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T20:42:34Z","timestamp":1784580154000},"page":"e90783-e90783","source":"Crossref","is-referenced-by-count":1,"title":["Body Image and Eating Disorder Education Chatbot, JEM, in Australia and Canada: First 6-Month Real-World Survey Evaluation"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9946-518X","authenticated-orcid":false,"given":"Gemma","family":"Sharp","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1005-8664","authenticated-orcid":false,"given":"Sara","family":"Marini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5233-9957","authenticated-orcid":false,"given":"Emily","family":"Tam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4470-3247","authenticated-orcid":false,"given":"Hao","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"R1","unstructured":"Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association Publishing; 2022. ISBN: 978-0-89042-576-3"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s40337-023-00738-7","article-title":"Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia-a rapid review","volume":"11","author":"Hay","journal-title":"J Eat Disord"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1007\/s40519-021-01162-z","article-title":"An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis","volume":"27","author":"Qian","journal-title":"Eat Weight Disord"},{"issue":"4","key":"R4","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1017\/bec.2018.3","article-title":"The relationship between body image concerns and weight-related behaviours of adolescents and emerging adults: a systematic review","volume":"34","author":"Shagar","journal-title":"Behav change"},{"key":"R5","unstructured":"Deloitte Access Economics. Paying the price report. Butterfly Foundation; 2024. URL: https:\/\/butterfly.org.au\/wp-content\/uploads\/2024\/10\/deloitte-au-eco-paying-the-price-second-edition-180724-new-Oct-24.pdf? [Accessed 03-07-2026]"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-024-01003-1","article-title":"Estimating additional health and social costs in eating disorder care for young people during the COVID-19 pandemic: implications for surveillance and system transformation","volume":"12","author":"Obeid","journal-title":"J Eat Disord"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-024-00986-1","article-title":"The financial and social impacts of the COVID-19 pandemic on youth with eating disorders, their families, clinicians and the mental health system: a mixed methods cost analysis","volume":"12","author":"Obeid","journal-title":"J Eat Disord"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2025.100824","article-title":"Digital interventions in mental health: an overview and future perspectives","volume":"40","author":"L\u00f6chner","journal-title":"Internet Interv"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1002\/wps.21299","article-title":"The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality","volume":"24","author":"Torous","journal-title":"World Psychiatry"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.2196\/44838","article-title":"An overview of chatbot-based mobile mental health apps: insights from app description and user reviews","volume":"11","author":"Haque","journal-title":"JMIR mHealth uHealth"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.2196\/43862","article-title":"Conversational agent interventions for mental health problems: systematic review and meta-analysis of randomized controlled trials","volume":"25","author":"He","journal-title":"J Med Internet Res"},{"issue":"7","key":"R12","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1177\/0706743719828977","article-title":"Chatbots and conversational agents in mental health: a review of the psychiatric landscape","volume":"64","author":"Vaidyam","journal-title":"Can J Psychiatry"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.2196\/79850","article-title":"The effectiveness of AI chatbots in alleviating mental distress and promoting health behaviors among adolescents and young adults: systematic review and meta-analysis","volume":"27","author":"Feng","journal-title":"J Med Internet Res"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.2196\/79677","article-title":"The development and use of AI chatbots for health behavior change: scoping review","volume":"28","author":"Fu","journal-title":"J Med Internet Res"},{"issue":"3","key":"R15","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1002\/eat.23662","article-title":"Effectiveness of a chatbot for eating disorders prevention: a randomized clinical trial","volume":"55","author":"Fitzsimmons-Craft","journal-title":"Int J Eat Disord"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/39934","article-title":"Using chatbot technology to improve Brazilian adolescents\u2019 body image and mental health at scale: randomized controlled trial","volume":"11","author":"Matheson","journal-title":"JMIR mHealth uHealth"},{"issue":"9","key":"R17","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1002\/eat.23798","article-title":"Development and usability testing of a chatbot to promote mental health services use among individuals with eating disorders following screening","volume":"55","author":"Shah","journal-title":"Int J Eat Disord"},{"issue":"4","key":"R18","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1002\/eat.70008","article-title":"User-centered development of a chatbot for diverse adolescents at high risk for eating disorders","volume":"59","author":"Gullo","journal-title":"Int J Eat Disord"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.2196\/70874","article-title":"The effectiveness of a chatbot single-session intervention for people on waitlists for eating disorder treatment: randomized controlled trial","volume":"27","author":"Sharp","journal-title":"J Med Internet Res"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-025-01225-x","article-title":"Co-design of a single session intervention chatbot for people on waitlists for eating disorder treatment: a qualitative interview and workshop study","volume":"13","author":"Sharp","journal-title":"J Eat Disord"},{"issue":"6","key":"R21","doi-asserted-by":"publisher","DOI":"10.2196\/27807","article-title":"Development of a positive body image chatbot (KIT) with young people and parents\/carers: qualitative focus group study","volume":"23","author":"Beilharz","journal-title":"J Med Internet Res"},{"issue":"11","key":"R22","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1002\/eat.24260","article-title":"Effects of chatbot components to facilitate mental health services use in individuals with eating disorders following online screening: an optimization randomized controlled trial","volume":"57","author":"Fitzsimmons-Craft","journal-title":"Int J Eat Disord"},{"key":"R23","unstructured":"Customer experience agent studio. Google Cloud. URL: https:\/\/cloud.google.com\/products\/conversational-agents?hl=en [Accessed 30-12-2025]"},{"key":"R24","doi-asserted-by":"crossref","unstructured":"Hart L Phillipou A . COVID has presented unique challenges for people with eating disorders. They\u2019ll need support beyond the pandemic. The Conversation. 2020. URL: https:\/\/theconversation.com\/covid-has-presented-unique-challenges-for-people-with-eating-disorders-theyll-need-support-beyond-the-pandemic-148903 [Accessed 03-03-2025]","DOI":"10.64628\/AA.peedrgq9p"},{"key":"R25","unstructured":"National mental health and wellbeing pandemic response plan. Australian Government, National Mental Health Commission; 2020. URL: https:\/\/www.mentalhealthcommission.gov.au\/sites\/default\/files\/2024-03\/national-mental-health-and-wellbeing-pandemic-response-plan.pdf [Accessed 03-07-2026]"},{"issue":"7","key":"R26","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4391","article-title":"Trials of intervention principles: evaluation methods for evolving behavioral intervention technologies","volume":"17","author":"Mohr","journal-title":"J Med Internet Res"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3390\/info16010011","article-title":"An exploratory investigation of chatbot applications in anxiety management: a focus on personalized interventions","volume":"16","author":"Manole","journal-title":"Information"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.2196\/19928","article-title":"Utilization of self-diagnosis health chatbots in real-world settings: case study","volume":"23","author":"Fan","journal-title":"J Med Internet Res"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1177\/2055207619871808","article-title":"Acceptability of artificial intelligence (AI)-led chatbot services in healthcare: a mixed-methods study","volume":"5","author":"Nadarzynski","journal-title":"Digit Health"},{"issue":"9","key":"R30","doi-asserted-by":"publisher","DOI":"10.2196\/44548","article-title":"Evaluating conversational agents for mental health: scoping review of outcomes and outcome measurement instruments","volume":"25","author":"Jabir","journal-title":"J Med Internet Res"},{"issue":"11","key":"R31","doi-asserted-by":"publisher","DOI":"10.2196\/12106","article-title":"An empathy-driven, conversational artificial intelligence agent (Wysa) for digital mental well-being: real-world data evaluation mixed-methods study","volume":"6","author":"Inkster","journal-title":"JMIR mHealth uHealth"},{"issue":"2","key":"R32","doi-asserted-by":"publisher","DOI":"10.2196\/mental.7785","article-title":"Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial","volume":"4","author":"Fitzpatrick","journal-title":"JMIR Ment Health"},{"issue":"C","key":"R33","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.invent.2017.10.002","article-title":"A fully automated conversational agent for promoting mental well-being: a pilot RCT using mixed methods","volume":"10","author":"Ly","journal-title":"Internet Interv"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1016\/j.bodyim.2022.11.007","article-title":"Evaluating change in body image concerns following a single session digital intervention","volume":"44","author":"Nemesure","journal-title":"Body Image"},{"key":"R35","unstructured":"Jargon J . A chatbot was designed to help prevent eating disorders. Then it gave dieting tips. The Wall Street Journal. 2023. URL: https:\/\/www.wsj.com\/articles\/eating-disorder-chatbot-ai-2aecb179#comments_sector [Accessed 30-12-2024]"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/50696","article-title":"Ethical challenges in AI approaches to eating disorders","volume":"25","author":"Sharp","journal-title":"J Med Internet Res"},{"issue":"1","key":"R37","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1037\/\/0033-2909.112.1.155","article-title":"A power primer","volume":"112","author":"Cohen","journal-title":"Psychol Bull"},{"issue":"2","key":"R38","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3758\/bf03193146","article-title":"G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","journal-title":"Behav Res Methods"},{"issue":"8","key":"R39","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1080\/0965254X.2021.1967428","article-title":"Breaking the psychological distance: the effect of immersive virtual reality on perceived novelty and user satisfaction","volume":"32","author":"Talukdar","journal-title":"J Strateg Mark"},{"key":"R40","unstructured":"Analytics. Google Cloud. URL: https:\/\/docs.cloud.google.com\/dialogflow\/es\/docs\/analytics [Accessed 30-12-2025]"},{"key":"R41","unstructured":"Qualtrics. URL: https:\/\/www.qualtrics.com [Accessed 30-12-2025]"},{"key":"R42","unstructured":"Fraud detection. Qualtrics. 2026. URL: https:\/\/www.qualtrics.com\/support\/survey-platform\/survey-module\/survey-checker\/fraud-detection [Accessed 01-01-2026]"},{"key":"R43","unstructured":"Prevent multiple submissions. Qualtrics. 2026. URL: https:\/\/www.qualtrics.com\/support\/survey-platform\/survey-module\/survey-options\/survey-protection\/#:~:text=Prevent%20Multiple%20Submissions,-Qtip%3A%20This%20option&text=This%20setting%20works%20by%20placing,them%20to%20take%20the%20survey [Accessed 01-01-2026]"},{"key":"R44","unstructured":"Intent matching. Google Cloud. URL: https:\/\/docs.cloud.google.com\/dialogflow\/es\/docs\/intents-matching#:~:text=When%20an%20end%2Duser%20writes,also%20known%20as%20intent%20classification [Accessed 30-04-2026]"},{"key":"R45","unstructured":"Guidance on demographic questions. McMaster University\u2014Research & Innovation. URL: https:\/\/research.mcmaster.ca\/home\/support-for-researchers\/ethics\/mcmaster-research-ethics-board-mreb\/guidance-on-demographic-questions [Accessed 01-01-2026]"},{"key":"R46","unstructured":"Brooke J . SUS: A 'Quick and Dirty' Usability Scale. In: Jordan PW Thomas B Weerdmeester WA McClelland AL , editors. Usability Evaluation in Industry. Taylor and Francis; 1996:189-194. ISBN: 9780429157011"},{"issue":"1","key":"R47","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.bodyim.2004.11.002","article-title":"Media exposure, mood, and body image dissatisfaction: an experimental test of person versus product priming","volume":"2","author":"Birkeland","journal-title":"Body Image"},{"key":"R48","unstructured":"Tiggemann M Zaccardo M . Mood and body dissatisfaction visual analogue scales [database record]. APA Psyc Tests. 2015. URL: https:\/\/psycnet.apa.org\/doiLanding?doi=10.1037%2Ft47509-000 [Accessed 16-07-2026]"},{"key":"R49","unstructured":"Cash TF . Cognitive-behavioral perspectives on body image. In: Cash TF Pruzinsky T , editors. Body Image: A Handbook of Theory, Research, and Clinical Practice. Guilford Press; 2002:269-276. ISBN: 9781572307773"},{"key":"R50","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.3.022806.091415","article-title":"Ecological momentary assessment","volume":"4","author":"Shiffman","journal-title":"Annu Rev Clin Psychol"},{"issue":"4","key":"R51","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1111\/bjhp.12334","article-title":"Motive- and appearance awareness-based explanations for body (dis)satisfaction following exercise in daily life","volume":"23","author":"Fuller-Tyszkiewicz","journal-title":"Br J Health Psychol"},{"issue":"1","key":"R52","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.beth.2016.09.007","article-title":"A person-by-situation account of why some people more frequently engage in upward appearance comparison behaviors in everyday life","volume":"48","author":"Rogers","journal-title":"Behav Ther"},{"issue":"7","key":"R53","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1038\/ijo.2012.68","article-title":"Body satisfaction, weight gain and binge eating among overweight adolescent girls","volume":"36","author":"Sonneville","journal-title":"Int J Obes (Lond)"},{"key":"R54","unstructured":"IBM SPSS software. IBM. URL: https:\/\/www.ibm.com\/spss [Accessed 30-12-2025]"},{"issue":"7139","key":"R55","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1136\/bmj.316.7139.1236","article-title":"What\u2019s wrong with Bonferroni adjustments","volume":"316","author":"Perneger","journal-title":"BMJ"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.1016\/j.npls.2016.01.001","article-title":"How to plan and perform a qualitative study using content analysis","volume":"2","author":"Bengtsson","journal-title":"Nurs Plus Open"},{"key":"R57","unstructured":"Beck JS . Cognitive Behavior Therapy: Basics and Beyond. 2nd ed. Guilford Press; 2011. ISBN: 9781609185060"},{"key":"R58","unstructured":"Hayes SC Strosahl KD Wilson KG . Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. 2nd ed. Guilford Press; 2011. ISBN: 9781609189624"},{"issue":"2","key":"R59","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jaac.2016.11.007","article-title":"Little treatments, promising effects? Meta-analysis of single-session interventions for youth psychiatric problems","volume":"56","author":"Schleider","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"4","key":"R60","doi-asserted-by":"publisher","DOI":"10.2196\/mental.9782","article-title":"Using psychological artificial intelligence (Tess) to relieve symptoms of depression and anxiety: randomized controlled trial","volume":"5","author":"Fulmer","journal-title":"JMIR Ment Health"},{"key":"R61","doi-asserted-by":"publisher","DOI":"10.2196\/89202","article-title":"\u201cFeasible but fragile\u201d: an inflection point for artificial intelligence in mental health care","volume":"27","author":"Clegg","journal-title":"J Med Internet Res"},{"issue":"2","key":"R62","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1037\/a0040360","article-title":"What five decades of research tells us about the effects of youth psychological therapy: a multilevel meta-analysis and implications for science and practice","volume":"72","author":"Weisz","journal-title":"Am Psychol"},{"issue":"4","key":"R63","doi-asserted-by":"publisher","DOI":"10.1056\/AIoa2400802","article-title":"Randomized trial of a generative AI chatbot for mental health treatment","volume":"2","author":"Heinz","journal-title":"NEJM AI"},{"key":"R64","doi-asserted-by":"publisher","DOI":"10.2196\/22769","article-title":"Applications and concerns of ChatGPT and other conversational large language models in health care: systematic review","volume":"26","author":"Wang","journal-title":"J Med Internet Res"},{"issue":"11","key":"R65","doi-asserted-by":"publisher","DOI":"10.2196\/38525","article-title":"Design and evaluation challenges of conversational agents in health care and well-being: selective review study","volume":"24","author":"Kocaballi","journal-title":"J Med Internet Res"},{"issue":"4","key":"R66","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1923","article-title":"CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions","volume":"13","author":"Eysenbach","journal-title":"J Med Internet Res"}],"container-title":["JMIR Human Factors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/humanfactors.jmir.org\/2026\/1\/e90783","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:24:19Z","timestamp":1785536659000},"score":1,"resource":{"primary":{"URL":"https:\/\/humanfactors.jmir.org\/2026\/1\/e90783"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":66,"URL":"https:\/\/doi.org\/10.2196\/90783","relation":{},"ISSN":["2292-9495"],"issn-type":[{"value":"2292-9495","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"article-number":"v13i1e90783"}}