Conversational agents in healthcare: a systematic review

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194 Citations (Scopus)
127 Downloads (Pure)


Objective: Our objective was to review the characteristics, current applications, and evaluation measures of conversational agents with unconstrained natural language input capabilities used for health-related purposes.

Methods: We searched PubMed, Embase, CINAHL, PsycInfo, and ACM Digital using a predefined search strategy. Studies were included if they focused on consumers or healthcare professionals; involved a conversational agent using any unconstrained natural language input; and reported evaluation measures resulting from user interaction with the system. Studies were screened by independent reviewers and Cohen’s kappa measured inter-coder agreement.

Results: The database search retrieved 1513 citations; 17 articles (14 different conversational agents) met the inclusion criteria. Dialogue management strategies were mostly finite-state and frame-based (6 and 7 conversational agents, respectively); agent-based strategies were present in one type of system. Two studies were randomized controlled trials (RCTs), 1 was cross-sectional, and the remaining were quasi-experimental. Half of the conversational agents supported consumers with health tasks such as self-care. The only RCT evaluating the efficacy of a conversational agent found a significant effect in reducing depression symptoms (effect size d = 0.44, p = .04). Patient safety was rarely evaluated in the included studies.

Conclusions: The use of conversational agents with unconstrained natural language input capabilities for health-related purposes is an emerging field of research, where the few published studies were mainly quasi-experimental, and rarely evaluated efficacy or safety. Future studies would benefit from more robust experimental designs and standardized reporting.

Protocol Registration: The protocol for this systematic review is registered at PROSPERO with the number CRD42017065917.
Original languageEnglish
Pages (from-to)1248–1258
Number of pages11
JournalJournal of the American Medical Informatics Association
Issue number9
Early online date13 Jul 2018
Publication statusPublished - 1 Sep 2018

Bibliographical note

Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • artificial intelligence [Mesh]
  • medical informatics [Mesh]
  • conversational agent
  • dialogue system


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