Engaging Artificial Intelligence (AI)-based chatbots in digital health: A systematic review

Abstract

The healthcare sector is rapidly evolving with the integration of Artificial Intelligence (AI). As AI technologies shift from rule-based expert systems to deep learning architectures, AI-based chatbots have emerged as innovative solutions to persistent challenges in the health domain. Given the growing concerns about their effectiveness and ethical implications, as well as the demand to optimise their potential in facilitating health outcomes, this study conducts a systematic review of existing research on AI-based chatbots, focusing on their applications and evaluation. A total of 348 articles, collected from eight databases—PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, IEEE, the ACM Digital Library, Scopus, and Web of Science - 20 of which were analysed. This review identifies four main research areas concerning AI-based chatbots: text quality, clinical efficacy, user engagement, and safety. It also highlights the lack of randomised controlled trials (RCTs) and the limited use of theoretical frameworks in evaluating their performance. Future research directions and practical solutions are discussed.