Conversational agents in healthcare: a systematic review.

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

A Virtual Conversational Agent for Teens with Autism: Experimental Results and Design Lessons

We present the design of an online social skills development interface for teenagers with autism spectrum disorder (ASD). The interface is intended to enable private conversation practice anywhere, anytime using a web-browser. Users converse informally with a virtual agent, receiving feedback on nonverbal cues in real-time, and summary feedback. The prototype was developed in consultation with an expert UX designer, two psychologists, and a pediatrician. Using the data from 47 individuals, feedback and dialogue generation were automated using a hidden Markov model and a schema-driven dialogue manager capable of handling multi-topic conversations. We conducted a study with nine high-functioning ASD teenagers. Through a thematic analysis of post-experiment interviews, identified several key design considerations, notably: 1) Users should be fully briefed at the outset about the purpose and limitations of the system, to avoid unrealistic expectations. 2) An interface should incorporate positive acknowledgment of behavior change. 3) Realistic appearance of a virtual agent and responsiveness are important in engaging users. 4) Conversation personalization, for instance in prompting laconic users for more input and reciprocal questions, would help the teenagers engage for longer terms and increase the system's utility

Reconsidering RepStat rules in dialectic games.

Prohibition of repeated statements has benefits for the tractability and predictability of dialogues carried out by machines, but doesn't match the real world behaviour of people. This gap between human and machine behaviour leads to problems when formal dialectical systems are applied in conversational AI contexts. However, the problem of handling statement repetition gives insight into wider issues that stem partly from the historical focus on formal dialectics to the near exclusion of descriptive dialectics. In this paper we consider the problem of balancing the needs of machines versus those of human participants through the consideration of both descriptive and formal dialectics integrated within a single overarching dialectical system. We describe how this approach can be supported through minimal extension of the Dialogue Game Description Language

Conversational affective social robots for ageing and dementia support

Socially assistive robots (SAR) hold significant potential to assist older adults and people with dementia in human engagement and clinical contexts by supporting mental health and independence at home. While SAR research has recently experienced prolific growth, long-term trust, clinical translation and patient benefit remain immature. Affective human-robot interactions are unresolved and the deployment of robots with conversational abilities is fundamental for robustness and humanrobot engagement. In this paper, we review the state of the art within the past two decades, design trends, and current applications of conversational affective SAR for ageing and dementia support. A horizon scanning of AI voice technology for healthcare, including ubiquitous smart speakers, is further introduced to address current gaps inhibiting home use. We discuss the role of user-centred approaches in the design of voice systems, including the capacity to handle communication breakdowns for effective use by target populations. We summarise the state of development in interactions using speech and natural language processing, which forms a baseline for longitudinal health monitoring and cognitive assessment. Drawing from this foundation, we identify open challenges and propose future directions to advance conversational affective social robots for: 1) user engagement, 2) deployment in real-world settings, and 3) clinical translation

Report on the future conversations workshop at CHIIR 2021

The Future Conversations workshop at CHIIR’21 looked to the future of search, recommen- dation, and information interaction to ask: where are the opportunities for conversational interactions? What do we need to do to get there? Furthermore, who stands to benefit?The workshop was hands-on and interactive. Rather than a series of technical talks, we solicited position statements on opportunities, problems, and solutions in conversational search in all modalities (written, spoken, or multimodal). This paper –co-authored by the organisers and participants of the workshop– summarises the submitted statements and the discussions we had during the two sessions of the workshop. Statements discussed during the workshop are available at https://bit.ly/FutureConversations2021Statements

A Survey on Conversational Search and Applications in Biomedicine

This paper aims to provide a radical rundown on Conversation Search (ConvSearch), an approach to enhance the information retrieval method where users engage in a dialogue for the information-seeking tasks. In this survey, we predominantly focused on the human interactive characteristics of the ConvSearch systems, highlighting the operations of the action modules, likely the Retrieval system, Question-Answering, and Recommender system. We labeled various ConvSearch research problems in knowledge bases, natural language processing, and dialogue management systems along with the action modules. We further categorized the framework to ConvSearch and the application is directed toward biomedical and healthcare fields for the utilization of clinical social technology. Finally, we conclude by talking through the challenges and issues of ConvSearch, particularly in Bio-Medicine. Our main aim is to provide an integrated and unified vision of the ConvSearch components from different fields, which benefit the information-seeking process in healthcare systems

An overview of the features of chatbots in mental health: A scoping review

Background: Chatbots are systems that are able to converse and interact with human users using spoken, written, and visual languages. Chatbots have the potential to be useful tools for individuals with mental disorders, especially those who are reluctant to seek mental health advice due to stigmatization. While numerous studies have been conducted about using chatbots for mental health, there is a need to systematically bring this evidence together in order to inform mental health providers and potential users about the main features of chatbots and their potential uses, and to inform future research about the main gaps of the previous literature. Objective: We aimed to provide an overview of the features of chatbots used by individuals for their mental health as reported in the empirical literature. Methods: Seven bibliographic databases (Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, IEEE Xplore, ACM Digital Library, and Google Scholar) were used in our search. In addition, backward and forward reference list checking of the included studies and relevant reviews was conducted. Study selection and data extraction were carried out by two reviewers independently. Extracted data were synthesised using a narrative approach. Chatbots were classified according to their purposes, platforms, response generation, dialogue initiative, input and output modalities, embodiment, and targeted disorders. Results: Of 1039 citations retrieved, 53 unique studies were included in this review. Those studies assessed 41 different chatbots. Common uses of chatbots were: therapy (n = 17), training (n = 12), and screening (n = 10). Chatbots in most studies were rule-based (n = 49) and implemented in stand-alone software (n = 37). In 46 studies, chatbots controlled and led the conversations. While the most frequently used input modality was writing language only (n = 26), the most frequently used output modality was a combination of written, spoken and visual languages (n = 28). In the majority of studies, chatbots included virtual representations (n = 44). The most common focus of chatbots was depression (n = 16) or autism (n = 10). Conclusion: Research regarding chatbots in mental health is nascent. There are numerous chatbots that are used for various mental disorders and purposes. Healthcare providers should compare chatbots found in this review to help guide potential users to the most appropriate chatbot to support their mental health needs. More reviews are needed to summarise the evidence regarding the effectiveness and acceptability of chatbots in mental health

A Flexible Schema-Guided Dialogue Management Framework: From Friendly Peer to Virtual Standardized Cancer Patient

A schema-guided approach to dialogue management has been shown in recent work to be effective in creating robust customizable virtual agents capable of acting as friendly peers or task assistants. However, successful applications of these methods in open-ended, mixed-initiative domains remain elusive -- particularly within medical domains such as virtual standardized patients, where such complex interactions are commonplace -- and require more extensive and flexible dialogue management capabilities than previous systems provide. In this paper, we describe a general-purpose schema-guided dialogue management framework used to develop SOPHIE, a virtual standardized cancer patient that allows a doctor to conveniently practice for interactions with patients. We conduct a crowdsourced evaluation of conversations between medical students and SOPHIE. Our agent is judged to produce responses that are natural, emotionally appropriate, and consistent with her role as a cancer patient. Furthermore, it significantly outperforms an end-to-end neural model fine-tuned on a human standardized patient corpus, attesting to the advantages of a schema-guided approach