{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T20:31:54Z","timestamp":1776889914590,"version":"3.51.2"},"reference-count":56,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T00:00:00Z","timestamp":1648512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>This paper reviews different types of conversational agents used in health care for chronic conditions, examining their underlying communication technology, evaluation measures, and AI methods. A systematic search was performed in February 2021 on PubMed Medline, EMBASE, PsycINFO, CINAHL, Web of Science, and ACM Digital Library. Studies were included if they focused on consumers, caregivers, or healthcare professionals in the prevention, treatment, or rehabilitation of chronic diseases, involved conversational agents, and tested the system with human users. The search retrieved 1087 articles. Twenty-six studies met the inclusion criteria. Out of 26 conversational agents (CAs), 16 were chatbots, seven were embodied conversational agents (ECA), one was a conversational agent in a robot, and another was a relational agent. One agent was not specified. Based on this review, the overall acceptance of CAs by users for the self-management of their chronic conditions is promising. Users\u2019 feedback shows helpfulness, satisfaction, and ease of use in more than half of included studies. Although many users in the studies appear to feel more comfortable with CAs, there is still a lack of reliable and comparable evidence to determine the efficacy of AI-enabled CAs for chronic health conditions due to the insufficient reporting of technical implementation details.<\/jats:p>","DOI":"10.3390\/s22072625","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T21:45:51Z","timestamp":1648590351000},"page":"2625","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":92,"title":["A Systematic Review on Healthcare Artificial Intelligent Conversational Agents for Chronic Conditions"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0200-617X","authenticated-orcid":false,"given":"Abdullah","family":"Bin Sawad","sequence":"first","affiliation":[{"name":"School of Computer Science, Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, Australia"}]},{"given":"Bhuva","family":"Narayan","sequence":"additional","affiliation":[{"name":"School of Communication, Faculty of Arts and Social Sciences, University of Technology Sydney, Sydney 2007, Australia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1172-902X","authenticated-orcid":false,"given":"Ahlam","family":"Alnefaie","sequence":"additional","affiliation":[{"name":"School of Computer Science, Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, Australia"}]},{"given":"Ashwaq","family":"Maqbool","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2007, Australia"}]},{"given":"Indra","family":"Mckie","sequence":"additional","affiliation":[{"name":"School of Communication, Faculty of Arts and Social Sciences, University of Technology Sydney, Sydney 2007, Australia"}]},{"given":"Jemma","family":"Smith","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, Australia"}]},{"given":"Berkan","family":"Yuksel","sequence":"additional","affiliation":[{"name":"School of Computer Science, Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, Australia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8332-278X","authenticated-orcid":false,"given":"Deepak","family":"Puthal","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering and Computer Science, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7745-9667","authenticated-orcid":false,"given":"Mukesh","family":"Prasad","sequence":"additional","affiliation":[{"name":"School of Computer Science, Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, Australia"}]},{"given":"A. Baki","family":"Kocaballi","sequence":"additional","affiliation":[{"name":"School of Computer Science, Faculty of Engineering and IT, University of Technology Sydney, Sydney 2007, Australia"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20701","DOI":"10.2196\/20701","article-title":"Artificial Intelligence-Based Conversational Agents for Chronic Conditions: Systematic Literature Review","volume":"22","author":"Schachner","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e14058","DOI":"10.2196\/14058","article-title":"Developing Embodied Conversational Agents for Coaching People in a Healthy Lifestyle: Scoping Review","volume":"22","author":"Kramer","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e19018","DOI":"10.2196\/19018","article-title":"Evaluating Smart Assistant Responses for Accuracy and Misinformation Regarding Human Papillomavirus Vaccination: Content Analysis Study","volume":"22","author":"Ferrand","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1093\/tbm\/ibz141","article-title":"A scoping review of patient-facing, behavioral health interventions with voice assistant technology targeting self-management and healthy lifestyle behaviors","volume":"10","author":"Sezgin","year":"2020","journal-title":"Transl. Behav. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e19127","DOI":"10.2196\/19127","article-title":"Technical Aspects of Developing Chatbots for Medical Applications: Scoping Review","volume":"22","author":"Safi","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_6","unstructured":"Griffin, A.C., Xing, Z., Khairat, S., Wang, Y., Bailey, S., Arguello, J., and Chung, A.E. (2021). Conversational Agents for Chronic Disease Self-Management: A Systematic Review. AMIA Annual Symposium Proceedings, American Medical Informatics Association."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1001\/jama.2020.2724","article-title":"Clinical, Legal, and Ethical Aspects of Artificial Intelligence\u2013Assisted Conversational Agents in Health Care","volume":"324","author":"McGreevey","year":"2020","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bickmore, T.W., Kimani, E., Trinh, H., Pusateri, A., Paasche-Orlow, M.K., and Magnani, J.W. (2018, January 5\u20138). Managing Chronic Conditions with a Smartphone-based Conversational Virtual Agent. Proceedings of the 18th International Conference on Intelligent Virtual Agents, IVA 2018, Sydney, NSW, Australia.","DOI":"10.1145\/3267851.3267908"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s10916-019-1237-1","article-title":"Using Health Chatbots for Behavior Change: A Mapping Study","volume":"43","author":"Pereira","year":"2019","journal-title":"J. Med. Syst."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e15018","DOI":"10.2196\/15018","article-title":"Use of the Chatbot \u201cVivibot\u201d to Deliver Positive Psychology Skills and Promote Well-Being Among Young People After Cancer Treatment: Randomized Controlled Feasibility Trial","volume":"7","author":"Greer","year":"2019","journal-title":"JMIR mHealth uHealth"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hebbar, A. (2017, January 3\u20135). Augmented intelligence: Enhancing human capabilities. Proceedings of the 2017 Third International Conference on Research in Computational Intelligence and Communication Networks (ICRCICN), Kolkata, India.","DOI":"10.1109\/ICRCICN.2017.8234515"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"746","DOI":"10.3389\/fpsyt.2019.00746","article-title":"Key Considerations for Incorporating Conversational AI in Psychotherapy","volume":"10","author":"Miner","year":"2019","journal-title":"Front. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/s41746-018-0066-9","article-title":"The digital scribe","volume":"1","author":"Coiera","year":"2018","journal-title":"NPJ Digit. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.chc.2016.07.012","article-title":"The Use of Health Information Technology Within Collaborative and Integrated Models of Child Psychiatry Practice","volume":"26","author":"Coffey","year":"2017","journal-title":"Child Adolesc. Psychiatr. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","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","year":"2017","journal-title":"Internet Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41746-020-0280-0","article-title":"Chatbots in the fight against the COVID-19 pandemic","volume":"3","author":"Miner","year":"2020","journal-title":"NPJ Digit. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/nbt.3495","article-title":"Digital medicine\u2019s march on chronic disease","volume":"34","author":"Kvedar","year":"2016","journal-title":"Nat. Biotechnol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"009","DOI":"10.1055\/s-0039-1688757","article-title":"Assistive Conversational Agent for Health Coaching: A Validation Study","volume":"58","author":"Fadhil","year":"2019","journal-title":"Methods Inf. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2444","DOI":"10.1001\/jama.2020.21518","article-title":"Conversational Agents in Health Care-Reply","volume":"324","author":"McGreevey","year":"2020","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1093\/tbm\/ibz043","article-title":"Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot","volume":"9","author":"Stephens","year":"2019","journal-title":"Transl. Behav. Med."},{"key":"ref_21","unstructured":"Australian Institute of Health and Welfare (2022, January 01). 3.3 Chronic Conditions, Chapter 3 Causes of Ill Health, Australia\u2019s Health 2018, Available online: https:\/\/www.aihw.gov.au\/getmedia\/6bc8a4f7-c251-4ac4-9c05-140a473efd7b\/aihw-aus-221-chapter-3-3.pdf.aspx."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.rasd.2011.06.004","article-title":"Portable data assistants: Potential in evidence-based practice autism treatment","volume":"6","author":"Dixon","year":"2012","journal-title":"Res. Autism Spectr. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.prro.2020.06.001","article-title":"National Cancer Institute Workshop on Artificial Intelligence in Radiation Oncology: Training the Next Generation","volume":"11","author":"Kang","year":"2020","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jclinepi.2009.06.006","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration","volume":"62","author":"Liberati","year":"2009","journal-title":"J. Clin. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.eswa.2019.03.054","article-title":"Survey of conversational agents in health","volume":"129","author":"Montenegro","year":"2019","journal-title":"Expert Syst. Appl."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e15823","DOI":"10.2196\/15823","article-title":"Responses of Conversational Agents to Health and Lifestyle Prompts: Investigation of Appropriateness and Presentation Structures","volume":"22","author":"Kocaballi","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1093\/jamia\/ocy072","article-title":"Conversational agents in healthcare: A systematic review","volume":"25","author":"Laranjo","year":"2018","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e17038","DOI":"10.2196\/17038","article-title":"The My Diabetes Coach Research Group Acceptability of an Embodied Conversational Agent for Type 2 Diabetes Self-Management Education and Support via a Smartphone App: Mixed Methods Study","volume":"8","author":"Baptista","year":"2020","journal-title":"JMIR mHealth uHealth"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.pedn.2019.09.004","article-title":"Getting Ready for Adult Healthcare: Designing a Chatbot to Coach Adolescents with Special Health Needs Through the Transitions of Care","volume":"49","author":"Beaudry","year":"2019","journal-title":"J. Pediatr. Nurs."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3928\/02793695-20110705-01","article-title":"Relational Agents as an Adjunct in Schizophrenia Treatment","volume":"49","author":"Puskar","year":"2011","journal-title":"J. Psychosoc. Nurs. Ment. Health Serv."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1109\/JBHI.2017.2782210","article-title":"Improving Health Outcomes Sooner Rather Than Later via an Interactive Website and Virtual Specialist","volume":"22","author":"Richards","year":"2017","journal-title":"IEEE J. Biomed. Health Inform."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1145\/3415223","article-title":"Simple and Steady Interactions Win the Healthy Mentality: Designing a Chatbot Service for the Elderly","volume":"4","author":"Ryu","year":"2020","journal-title":"Proc. ACM Hum.-Comput. Interact."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Schroeder, J., Wilkes, C., Rowan, K., Toledo, A., Paradiso, A., Czerwinski, M., Mark, G., and Linehan, M.M. (2018, January 21\u201326). Pocket Skills: A conversational Mobile web app to support dialectical behavioral therapy. Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems, Montreal, QC, Canada.","DOI":"10.1145\/3173574.3173972"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e12856","DOI":"10.2196\/12856","article-title":"When Chatbots Meet Patients: One-Year Prospective Study of Conversations between Patients with Breast Cancer and a Chatbot","volume":"5","author":"Chaix","year":"2019","journal-title":"JMIR Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e12996","DOI":"10.2196\/12996","article-title":"A Virtual Agent to Support Individuals Living with Physical and Mental Comorbidities: Co-Design and Acceptability Testing","volume":"21","author":"Easton","year":"2019","journal-title":"J. Med. Internet Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e15806","DOI":"10.2196\/15806","article-title":"A Smartphone-Based Health Care Chatbot to Promote Self-Management of Chronic Pain (SELMA): Pilot Randomized Controlled Trial","volume":"8","author":"Kowatsch","year":"2020","journal-title":"JMIR mHealth uHealth"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e12106","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","year":"2018","journal-title":"JMIR mHealth uHealth"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4018\/IJEHMC.2017100102","article-title":"CARMIE: A conversational medication assistant for heart failure","volume":"8","author":"Lobo","year":"2017","journal-title":"Int. J. E-Health Med. Commun."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"118","DOI":"10.3389\/frobt.2019.00118","article-title":"Socio-Cognitive Engineering of a Robotic Partner for Child\u2019s Diabetes Self-Management","volume":"6","author":"Neerincx","year":"2019","journal-title":"Front. Robot. AI"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Rehman, U.U., Chang, D.J., Jung, Y., Akhtar, U., Razzaq, M.A., and Lee, S. (2020). Medical Instructed Real-Time Assistant for Patient with Glaucoma and Diabetic Conditions. Appl. Sci., 10.","DOI":"10.3390\/app10072216"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1258\/jtt.2008.003016","article-title":"Using Personal Digital Assistants to improve self-care in oral health","volume":"14","author":"Levitz","year":"2008","journal-title":"J. Telemed. Telecare"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.chb.2017.03.071","article-title":"Changing stigmatizing attitudes to mental health via education and contact with embodied conversational agents","volume":"73","author":"Sebastian","year":"2017","journal-title":"Comput. Hum. Behav."},{"key":"ref_43","first-page":"146","article-title":"Automated Spoken Dialog System for Home Care and Data Acquisition from Chronic Patients","volume":"95","author":"Azzini","year":"2003","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.intcom.2010.02.001","article-title":"Maintaining reality: Relational agents for antipsychotic medication adherence","volume":"22","author":"Bickmore","year":"2010","journal-title":"Interact. Comput."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e13440","DOI":"10.2196\/13440","article-title":"A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study","volume":"21","author":"Bott","year":"2019","journal-title":"J. Med. Internet Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"42656","DOI":"10.1038\/srep42656","article-title":"Virtual human as a new diagnostic tool, a proof of concept study in the field of major depressive disorders","volume":"7","author":"Philip","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ijmedinf.2019.05.013","article-title":"A smartphone Chatbot application to optimize monitoring of older patients with cancer","volume":"128","author":"Piau","year":"2019","journal-title":"Int. J. Med. Inform."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Shamekhi, A., and Bickmore, T. (2018). Breathe Deep: A breath-sensitive interactive meditation coach. Proceedings of the ACM International Conference Proceeding Series, Association for Computing Machinery.","DOI":"10.1145\/3240925.3240940"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s10916-017-0771-y","article-title":"A Therapy System for Post-Traumatic Stress Disorder Using a Virtual Agent and Virtual Storytelling to Reconstruct Traumatic Memories","volume":"41","author":"Tielman","year":"2017","journal-title":"J. Med. Syst."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Puthal, D., Mir, Z.H., Filali, F., and Menouar, H. (2013, January 2\u20136). Cross-layer architecture for congestion control in Vehicular Ad-hoc Networks. Proceedings of the 2013 International Conference on Connected Vehicles and Expo (ICCVE), Las Vegas, NV, USA.","DOI":"10.1109\/ICCVE.2013.6799921"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1145\/3398039","article-title":"Lightweight Multi-party Authentication and Key Agreement Protocol in IoT-based E-Healthcare Service","volume":"17","author":"Sahu","year":"2021","journal-title":"ACM Trans. Multimed. Comput. Commun. Appl. (TOMM)"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.intcom.2009.12.001","article-title":"Response to a relational agent by hospital patients with depressive symptoms","volume":"22","author":"Bickmore","year":"2010","journal-title":"Interact. Comput."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e10211","DOI":"10.2196\/10211","article-title":"A Realistic Talking Human Embodied Agent Mobile Phone Intervention to Promote HIV Medication Adherence and Retention in Care in Young HIV-Positive African American Men Who Have Sex With Men: Qualitative Study","volume":"6","author":"Dworkin","year":"2018","journal-title":"JMIR mHealth uHealth"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jpdc.2018.10.007","article-title":"Secure authentication and load balancing of distributed edge datacenters","volume":"124","author":"Puthal","year":"2019","journal-title":"J. Parallel Distrib. Comput."},{"key":"ref_55","first-page":"43","article-title":"Energy Efficient Protocols for Wireless Sensor Networks: A Survey and Approach","volume":"44","author":"Sahoo","year":"2012","journal-title":"Int. J. Comput. Appl."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Puthal, D., Nepal, S., Ranjan, R., and Chen, J. (2016, January 12\u201314). A secure big data stream analytics framework for disaster management on the cloud. Proceedings of the 2016 IEEE 18th International Conference on High Performance Computing and Communications; IEEE 14th International Conference on Smart City; IEEE 2nd International Conference on Data Science and Systems (HPCC\/SmartCity\/DSS), Sydney, NSW, Australia.","DOI":"10.1109\/HPCC-SmartCity-DSS.2016.0170"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/7\/2625\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:45:50Z","timestamp":1760136350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/22\/7\/2625"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,29]]},"references-count":56,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["s22072625"],"URL":"https:\/\/doi.org\/10.3390\/s22072625","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,29]]}}}