Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.
Psychology Programme, School of Social Sciences, Nanyang Technological University Singapore, Singapore, Singapore.
J Med Internet Res. 2023 Jul 18;25:e45984. doi: 10.2196/45984.
Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users' mental health.
This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale.
The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple's App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs.
We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 "Social support (emotional)," 4.1 "Instructions for how to perform a behavior," 11.2 "Reduce negative emotions," and 6.1 "Demonstration of the behavior." One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts.
Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions.
精神障碍在全球范围内造成了大量与健康相关的负担。移动健康干预措施越来越多地被用于促进心理健康和幸福感，因为它们可以改善治疗的可及性并降低相关成本。行为改变是旨在改善心理健康和幸福感的干预措施的一个重要特征。需要辨别可以促进此类干预措施中行为改变的有效成分，最终改善用户的心理健康。
本研究系统地确定了目前在应用商店中可用的心理健康对话代理（CA），并评估了所使用的行为改变技术（BCT）。我们进一步描述了它们的主要功能、技术方面以及使用移动应用程序评级量表评估的参与度、功能性、美学和信息方面的质量。
该应用程序的搜索、选择和评估是根据系统评价方法改编的，包括搜索、两轮选择和根据预定义标准进行的评估。我们使用 42matters 对苹果的 App Store 和谷歌 Play 进行了系统的应用程序搜索，搜索内容包括英语 CA 且自 2020 年 1 月以来上传或更新的应用程序，并提供了旨在改善心理健康和幸福感以及评估或管理精神障碍的干预措施。至少由两名评审员对应用程序进行了测试。使用行为改变技术分类学 v1，这是一个包含 93 种 BCT 的综合清单，来识别 CA 中的特定行为改变成分。
我们发现了 18 种基于应用程序的心理健康 CA。大多数 CA 在两个应用商店的用户评分都低于 1000（12/18，67%），并针对多种疾病，如压力、焦虑和抑郁（13/18，72%）。所有 CA 都涉及超过 1 种精神障碍。大多数 CA（14/18，78%）使用认知行为疗法（CBT）。一半（9/18，50%）的 CA 是基于规则的（即，仅提供预定的答案），另一半（9/18，50%）是人工智能增强的（即，包括开放式问题）。CA 使用了 48 种不同的 BCT，平均使用 15 种（SD 8.77；范围 4-30）BCT。最常见的 BCT 是 3.3“社会支持（情感）”、4.1“如何执行行为的说明”、11.2“减少负面情绪”和 6.1“行为示范”。声称基于 CBT 的 CA 中有三分之一（5/14，36%）不包括核心 CBT 概念。
心理健康 CA 主要针对各种心理健康问题，如压力、焦虑和抑郁，反映了广泛的干预重点。确定的最常见 BCT 用于促进对精神障碍的自我管理，几乎没有治疗元素。CA 开发者在设计心理健康 CA 时应考虑信息质量、用户保密性、可及性和紧急管理。未来的研究应评估人工智能在促进 CA 中行为改变方面的作用，并确定在循证心理治疗中选择 BCT 的方法，以实现有效的数字心理健康干预措施的系统、一致和透明的开发和评估。
