Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 24, 2023
Date Accepted: Nov 16, 2023
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Systematic Review of Chatbots that Deliver Contraceptive Services
ABSTRACT
Background:
A chatbot is a computer program that is designed to simulate conversation with humans. Chatbots may offer rapid, responsive, and private contraceptive information, counselling and linkages to products and services, which could improve contraceptive knowledge, attitudes and behaviors.
Objective:
This review aimed to systematically collate and interpret evidence to determine whether and how chatbots improve contraceptive knowledge, attitudes and behaviors. Contraceptive knowledge, attitudes and behaviors include, access to contraceptive information, understanding of contraceptive information, access to contraceptive services, contraceptive uptake, contraceptive continuation and contraceptive communication or negotiation skills. A secondary aim of the review is to identify and summarize best practice recommendations for chatbot development to improve contraceptive outcomes including the cost effectiveness of chatbots where evidence is available.
Methods:
We systematically searched the peer-reviewed and gray literature (2010-2022) for papers which evaluated chatbots offering contraceptive information and services where there was reporting of intervention outcomes and data collection methods.
Results:
We identified 15 sources, 8 original research papers and 7 gray literature papers. One RCT suggested that chatbots have no effect on intention to use contraception, a small cohort study suggests increased uptake of contraception among adolescent girls and a development report suggests no impact on access to services. There is poor quality evidence to suggest increased contraceptive knowledge from interacting with chatbot content. User feedback suggests that chatbots may be experienced as acceptable, convenient, anonymous, and private but also as incompetent, inconvenient, and unsympathetic. The best practice guidance on development of chatbots to improve contraceptive knowledge, attitudes and behaviors is consistent with that in the literature on chatbots in other health care fields.
Conclusions:
We found limited and conflicting evidence on chatbots to improve contraceptive knowledge, attitudes and behavior. Further research is needed to understand the impact of chatbot interventions in comparison to alternative technologies including research that acknowledges the variation in chatbot interventions and seeks to identify the key features associated with improved contraceptive outcomes.
Citation
