The Development and Use of AI Chatbots for Health Behavior Change: Scoping Review

Artificial intelligence (AI) chatbots are technologies that facilitate human-computer interaction through communication in a natural language format. By increasing cost-effectiveness, interaction, autonomy, personalization, and support, mobile health interventions can benefit health behavior change and make it more natural and intuitive.

This study aimed to provide an up-to-date and practical overview of how text-based AI chatbots are designed, developed, and evaluated across 8 health behaviors, including their roles, theoretical foundations, health behavior change techniques, technology development workflow, and performance validation framework.

In accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework, relevant studies published before March 2024 were identified from 9 bibliographic databases (ie, PubMed, CINAHL, MEDLINE, Embase, Web of Science, Scopus, APA PsycINFO, IEEE Xplore, and ACM Digital Library). Two stages (ie, title and abstract screening followed by full-text screening) were conducted to screen the eligibility of the papers via Covidence software. Finally, we extracted the data via Microsoft Excel software and used a narrative approach, content analysis, and evidence map to synthesize the reported results.

Our systematic search initially identified 10,508 publications, 43 of which met our inclusion criteria. AI chatbots primarily served 2 main roles: routine coach (27/43, 62.79%) and on-demand assistant (12/43, 27.91%), while 4 studies (4/43, 9.30%) integrated both roles. Frameworks like cognitive behavioral therapy (13/24, 54.17%) and behavior change techniques, such as goal setting, feedback and monitoring, and social support, guided the development of theory-driven AI chatbots. Noncode platforms (eg, Google Dialogflow and IBM Watson) integrated with social messaging platforms (eg, Facebook Messenger) were commonly used to develop AI chatbots (23/43, 53.49%). AI chatbots have been evaluated across 4 domains: technical performance (17/43, 39.53%), usability (17/43, 39.53%), engagement (37/43, 86.05%), and health behavior change (33/43, 76.74%). Evidence for health behavior changes remains exploratory but promising. Among 33 studies with 120 comparisons, 81.67% (98/120) showed positive outcomes, though only 35.83% (43/120) had moderate or larger effects (Hedges g or odds ratio or Cohen d>0.5). Most involved nonclinical (36/43, 83.72%) and adults (23/43, 53.49%), and a few were randomized controlled trials (14/43, 32.56%). Benefits were mainly seen in physical activity, smoking cessation, stress management, and diet, with limited evidence for other behaviors. Findings were inconsistent regarding the influence of long-term effects, intervention duration, modality, and engagement on health behavior change outcomes.

The exploratory synthesis provides a roadmap for developing and evaluating AI chatbots in health behavior change, highlighting the need for further research on cost, implementation outcomes, and underexplored behaviors such as sleep, weight management, sedentary behavior, and alcohol use.