The Use and Promise of Conversational Agents in Digital Health

OBJECTIVES: To describe the use and promise of conversational agents in digital health-including health promotion andprevention-and how they can be combined with other new technologies to provide healthcare at home. METHOD: A narrative review of recent advances in technologies underpinning conversational agents and their use and potential for healthcare and improving health outcomes. RESULTS: By responding to written and spoken language, conversational agents present a versatile, natural user interface and have the potential to make their services and applications more widely accessible. Historically, conversational interfaces for health applications have focused mainly on mental health, but with an increase in affordable devices and the modernization of health services, conversational agents are becoming more widely deployed across the health system. We present our work on context-aware voice assistants capable of proactively engaging users and delivering health information and services. The proactive voice agents we deploy, allow us to conduct experience sampling in people's homes and to collect information about the contexts in which users are interacting with them. CONCLUSION: In this article, we describe the state-of-the-art of these and other enabling technologies for speech and conversation and discuss ongoing research efforts to develop conversational agents that "live" with patients and customize their service offerings around their needs. These agents can function as 'digital companions' who will send reminders about medications and appointments, proactively check in to gather self-assessments, and follow up with patients on their treatment plans. Together with an unobtrusive and continuous collection of other health data, conversational agents can provide novel and deeply personalized access to digital health care, and they will continue to become an increasingly important part of the ecosystem for future healthcare delivery.