Skip to main content

Intelligent Conversational Agents in Global Health

  • Living reference work entry
  • First Online:
Innovations in Global Mental Health

Abstract

Conversational agents are software programs that emulate conversation with humans through natural language. Conversational agents are beginning to be used to automate the provision and collection of health-related information and assist in the training of clinicians and, in some applications, used to provide therapeutic counseling. This technology has the potential to help address some of the shortages of human resources for health and clinical services worldwide. This chapter provides an overview of CAs in healthcare and public health and discusses the practical and ethical challenges associated with them. Specific issues discussed include equitable access, biases in design, safety issues, and more. Recommendations to address these challenges are offered along with a call for collaborative establishment of best practices and international ethics guidelines for technologies that simulate and replace humans in health-related services.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Agarwal R, Sampath H, Indurkhya B. A usability study on natural interaction devices with ASD children. In: Proceedings of 7th international conference on universal access in human-computer interaction: users and contexts diversity, vol. 2. Presented at: 7th international conference on universal access in human-computer interaction: users and contexts diversity, July 21–26, 2013, Las Vegas. Heidelberg/Berlin: Springer; 2013. p. 21–6.

    Google Scholar 

  • Alcorn A, Pain H, Rajendran G, Smith T, Lemon O, Porayska-Pomsta K, … Bernardini S. Social communication between virtual characters and children with autism. In: Biswas G, Bull S, Kay J, Mitrovic A, editors. Artificial intelligence in education. Heidelberg/Berlin: Springer; 2011. p. 7–14.

    Google Scholar 

  • Auckland UniServices Ltd. About SPARX. n.d. Retrieved from https://www.sparx.org.nz/about

  • Azzini I, Falavigna D, Giorgino T, Gretter R, Quaglini S, Rognoni C, Stefanelli M. Automated spoken dialog system for home care and data acquisition from chronic patients. Stud Health Technol Inform. 2003;95:146–51.

    PubMed  Google Scholar 

  • Bernardini S, Porayska-Pomsta K, Smith TJ. ECHOES: an intelligent serious game for fostering social communication in children with autism. Inf Sci. 2014;264: 41–60.

    Article  Google Scholar 

  • Beveridge M, Fox J. Automatic generation of spoken dialogue from medical plans and ontologies. J Biomed Inform. 2006;39(5):482–99.

    Article  Google Scholar 

  • Bickmore TW, Puskar K, Schlenk EA, Pfeifer LM, Sereika SM. Maintaining reality: relational agents for antipsychotic medication adherence. Interact Comput. 2010;22(4):276–88.

    Article  Google Scholar 

  • Bickmore TW, Silliman RA, Nelson K, et al. A randomized controlled trial of an automated exercise coach for older adults. J Am Geriatr Soc. 2013;61(10):1676–83.

    Article  Google Scholar 

  • Black LA, McTear M, Black N, Harper R, Lemon M. Appraisal of a conversational artefact and its utility in remote patient monitoring. In: 18th IEEE symposium on computer-based medical systems (CBMS’05): IEEE; 2005. p. 506–8.

    Google Scholar 

  • Cheek C, Bridgman H, Fleming T, Cummings E, Ellis L, Lucassen MF, Shepherd M, Skinner T. Views of young people in rural Australia on SPARX, a fantasy world developed for New Zealand youth with depression. JMIR Serious Games. 2014;2(1):e3.

    Article  Google Scholar 

  • Chung K, Park RC. Chatbot-based healthcare service with a knowledge base for cloud computing. Cluster Comput. 2018;5:1–13.

    Google Scholar 

  • DeVault D, Artstein R, Benn G, Dey T, Fast E, Gainer A, … Morency LP. Simsensei kiosk: a virtual human interviewer for healthcare decision support. In: Proceedings of the 2014 international conference on autonomous agents and multi-agent systems. AAMAS; 2014. p. 1061–8.

    Google Scholar 

  • Elliott L, Golub A, Price M, Bennett A. More than just a game? Combat-themed gaming among recent veterans with posttraumatic stress disorder. Games Health J. 2015;4(4):271–7. https://doi.org/10.1089/g4h.2014.0104.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fitzpatrick KK, Darcy A, Vierhile M. Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR Ment Health. 2017;4(2):e19.

    Article  Google Scholar 

  • Gianfrancesco MA, Tamang S, Yazdany J, Schmajuk G. Potential biases in machine learning algorithms using electronic health record data. JAMA Intern Med. 2018;178(11):1544–7. https://doi.org/10.1001/jamainternmed.2018.3763.

    Article  PubMed  PubMed Central  Google Scholar 

  • Giorgino T, Azzini I, Rognoni C, Rognoni C, Quaglini S, Stefanelli M, … Falavigna D. Automated spoken dialogue system for hypertensive patient home management. Int J Med Inform. 2005;74(2–4):159–67.

    Article  Google Scholar 

  • Griol D, Carbó J, Molina JM. An automatic dialog simulation technique to develop and evaluate interactive conversational agents. Appl Artif Intell. 2013;27(9): 759–80.

    Article  Google Scholar 

  • Harper R, Nicholl P, McTear M, Wallace J, Black LA, Kearney P. Automated phone capture of diabetes patients readings with consultant monitoring via the web. In: 15th annual IEEE international conference and workshop on the engineering of computer based systems (ECBS 2008), vol. 2008: IEEE; 2008. p. 219–26.

    Google Scholar 

  • Hopkins IM, Gower MW, Perez TA, Smith DS, Amthor FR, Wimsatt FC, Biasini FJ. Avatar assistant: improving social skills in students with an ASD through a computer-based intervention. J Autism Dev Disord. 2011;41(11):1543–55.

    Article  Google Scholar 

  • Hudlicka E. Virtual affective agents and therapeutic games. In: Luxton DD, editor. Artificial intelligence in behavioral and mental healthcare. San Diego: Elsevier/Academic; 2015.

    Google Scholar 

  • Hudlicka E, Lisetti C, Hodge D, Paiva A, Rizzo A, Wagner E. Artificial agents for psychotherapy. In: Proceedings of the AAAI spring symposium on emotion, personality and social behavior. TR SS-08-04. Menlo Park: AAAI; 2008. p. 60–4.

    Google Scholar 

  • Inkster B, Sarda S, Subramanian V. An empathy-driven, conversational artificial intelligence agent (Wysa) for digital mental well-being: real-world data evaluation mixed-methods study. JMIR Mhealth Uhealth. 2018;6(11):e12106.

    Article  Google Scholar 

  • International Technology Education Association. Standards for technological literacy. 2007. https://www.iteea.org/File.aspx?id=67767

  • Kang S, Gratch J. Virtual humans elicit socially anxious interactants’ verbal self-disclosure. Comput Anim Virtual Worlds. 2010;21(3–4):473–82.

    Google Scholar 

  • Kang S, Gratch J. Socially anxious people reveal more personal information with virtual counselors that talk about themselves using intimate human back stories. Stud Health Technol Inform. 2012;181:202–6.

    PubMed  Google Scholar 

  • Kang S, Gratch J, Sidner C. Towards building a virtual counselor: modeling nonverbal behavior during intimate self-disclosure. In: Conitzer, Winikoff, Padgham, van der Hoek, editors. Proceedings of the international conference on autonomous agents and mutliagent systems (AAMAS), Valencia. 2012. p. 4–8.

    Google Scholar 

  • Kenny P, Parsons TD. Embodied conversational virtual human patients. In: Perez-Marin C, Pascual-Nieto I, editors. Conversational agents and natural language interaction: techniques and effective practices. Hereshey: IGI Global; 2011. p. 254–81.

    Chapter  Google Scholar 

  • Kenny P, Hartholt A, Gratch J, Swartout W, Traum D, Marsella S, Piepol D. Building interactive virtual humans for training environments. In: Proceedings of I/ITSEC, November 2007.

    Google Scholar 

  • Kenny P, Rizzo AA, Parsons TD, Gratch J, Swartout W. A virtual human agent for training novice therapist clinical interviewing skills. Annu Rev Cyberther Telemed. 2007b;5:77–83.

    Google Scholar 

  • Kenny P, Parsons TD, Gratch J, Leuski A, Rizzo AA. Virtual patients for clinical therapist skills training. In: Pelachaud C, Martin JC, André E, Chollet G, Karpouzis K, Pelé D, editors. Intelligent virtual agents. IVA 2007. Lecture notes in computer science, vol. 4722. Berlin/Heidelberg: Springer; 2007c.

    Google Scholar 

  • Konstantinidis E, Hitoglou-Antoniadou M, Luneski A, Bamidis P, Nikolaidou M. Using affective avatars and rich multimedia content for education of children with autism. In: Proceedings of 2nd international conference on pervasive technologies related to assistive environment. Presented at: PETRA ‘09, 2009, Corfu. New York: ACM; 2009. p. 1–6.

    Google Scholar 

  • Ku J, Han K, Lee HR, Jang HJ, Kim KU, Park SH. VR-based conversation training program for patients with schizophrenia: a preliminary clinical trial. Cyberpsychol Behav. 2007;10(4):567–74.

    Article  Google Scholar 

  • Lahiri U, Bekele E, Dohrmann E, Warren Z, Sarkar N. Design of a virtual reality based adaptive response technology for children with autism spectrum disorder. In: D’Mello S, Graesser A, Schuller B, Martin JC, editors. ACII 2011: affective computing and intelligent interaction, vol. 2011. Heidelberg/Berlin: Springer; 2011. p. 165–74.

    Google Scholar 

  • Laranjo L, Dunn AG, Tong HL, Kocaballi AB, Chen J, Bashir R, et al. Conversational agents in healthcare: a systematic review. J Am Med Inform Assoc. 2018;25(9):1248–58. https://doi.org/10.1093/jamia/ocy072.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lucas GM, Rizzo A, Gratch J, Scherer S, Stratou S, Boberg J, Morency LP. Reporting mental health symptoms: breaking down barriers to care with virtual human interviewers. Front Robot AI. 2017;4:1–9.

    Article  Google Scholar 

  • Luxton DD. Recommendations for the ethical use and design of artificial intelligent care providers. Artif Intell Med. 2014a;62(1):1–10. https://doi.org/10.1016/j.artmed.2014.06.004. PMID: 25059820.

    Article  PubMed  Google Scholar 

  • Luxton DD. Artificial intelligence in psychological practice: current and future applications and implications. Prof Psychol Res Pract. 2014b;45(5):332–9. https://doi.org/10.1037/a0034559.

    Article  Google Scholar 

  • Luxton DD. Artificial intelligence in behavioral and mental healthcare. San Diego: Elsevier/Academic; 2015.

    Google Scholar 

  • Luxton DD. Ethical challenges of conversational agents in global public health. Bull World Health Organ. 2020;98:285.

    Article  Google Scholar 

  • Luxton DD, Hudlicka E. Intelligent virtual agents in healthcare: ethics and application considerations. In: Jotterand F, Ienca M, Liang M, editors. Ethics of artificial intelligence in brain & mental health. Springer Nature. (in press).

    Google Scholar 

  • Luxton DD, Riek L. Handbook of rehabilitation psychology, 3rd ed. In: Brenner L, Reid-Arndt BS, Elliott TR, et al., editors. Artificial intelligence and robotics for rehabilitation. Washington, DC: American Psychological Association Books; 2019.

    Chapter  Google Scholar 

  • Merry SN, Stasiak K, Shepherd M, Frampton C, Fleming T, Lucassen MFG. The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ. 2012;344:e2598.

    Article  Google Scholar 

  • Milne M, Powers D, Leibbrandt R. Development of a software-based social tutor for children with autism spectrum disorders. In: Proceedings of 21st annual conference on Australian computer interaction special interest group design open 24/7. 2009 Presented at: OZCHI ‘09; November 23–27, 2009, Melbourne; 2009. p. 265–8. https://doi.org/10.1145/1738826.1738870.

  • Parsons TD, Kenny P, Ntuen C, Pataki CS, Pato M, Rizzo AA, … Sugar J. Objective structured clinical interview training using a virtual human patient. Stud Health Technol Inform. 2008;132:357–62.

    Google Scholar 

  • Pataki C, Pato MT, Sugar J, Rizzo AS, Parsons TD, St. George C, Kenny P. Virtual patients as novel teaching tools in psychiatry. Acad Psychiatry. 2012;36(5): 398–400.

    Article  Google Scholar 

  • Peyrou B, Vignaux JJ, André A. Artificial intelligence and health care. In: André A, editor. Digital medicine. Health informatics. Cham: Springer; 2019.

    Google Scholar 

  • Philip P, Micoulaud-Franchi J-A, Sagaspe P, De Sevin E, Olive J, Bioulac S, Sauteraud A. Virtual human as a new diagnostic tool, a proof of concept study in the field of major depressive disorders. Sci Rep. 2017;7:42656.

    Article  CAS  Google Scholar 

  • Prendinger H, Ishizuka M, editors. Life-like characters: tools, affective functions, and applications (cognitive technologies). Berlin/Heidelberg: Springer; 2004.

    Google Scholar 

  • Provoost S, Lau HM, Ruwaard J, Riper H. Embodied conversational agents in clinical psychology: a scoping review. J Med Internet Res. 2017;19:e151. https://doi.org/10.2196/jmir.6553.

    Article  PubMed  PubMed Central  Google Scholar 

  • Raghavan V, Rangaswamy T. Challenges and opportunities in delivering mental health care in low- and middle-income countries. In: Okpaku S, editor. Innovations in global mental health. Cham: Springer; 2019.

    Google Scholar 

  • Ribeiro P, Araujo BD, Raposo A. ComFiM: a cooperative serious game to encourage the development of communicative skills between children with autism. In: Proceedings of 2014 Brazilian symposium on computer games and digital entertainment. Presented at: Computer Games and Digital Entertainment (SBGAMES), November 12–14, 2014, Porto Alegro. IEEE Computer Society; 2014. p. 148–57. https://doi.org/10.1109/SBGAMES.2014.19.

  • Rizzo AA, Talbot T. Virtual reality standardized patients for clinical training. In: Combs CD, Sokolowski JA, Banks CM, editors. The digital patient: advancing medical research, education, and practice. New York: Wiley; 2016. p. 257–72.

    Google Scholar 

  • Russoniello CV, Fish M, O’Brien K. The efficacy of casual videogame play in reducing clinical depression: a randomized controlled study. Games Health J. 2013;2(6): 341–6. https://doi.org/10.1089/g4h.2013.0010.

    Article  PubMed  Google Scholar 

  • Sensely, Inc. Product. n.d. Retrieved from https://www.sensely.com/product

  • Smith MJ, Ginger EJ, Wright M, Wright K, Boteler-Humm L, Olsen D, … Fleming MF. Virtual reality job interview training for individuals with psychiatric disabilities. J Nerv Ment Dis. 2014;202(9):659–67.

    Article  Google Scholar 

  • Woebot Labs Inc. The science behind Woebot. n.d. Retrieved from http://www.wobot.io/the-science

  • World Health Organization (WHO). Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth 2009. 2010. https://www.who.int/goe/publications/goe_telemedicine_2010.pdf

  • World Health Organization (WHO). WHO’s mental health atlas 2017 highlights global shortage of health workers trained in mental health. 2017. https://www.who.int/hrh/news/2018/WHO-MentalHealthAtlas2017-highlights-HW-shortage/en/

  • Wysa Ltd. Meet Wysa. n.d. Retrieved from http://www.wysa.io

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David D. Luxton .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Luxton, D.D., Sirotin, A. (2020). Intelligent Conversational Agents in Global Health. In: Okpaku, S. (eds) Innovations in Global Mental Health. Springer, Cham. https://doi.org/10.1007/978-3-319-70134-9_11-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-70134-9_11-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-70134-9

  • Online ISBN: 978-3-319-70134-9

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics