Are nutrition and physical activity chatbots feasible and acceptable to adolescents? A systematic scoping review

Rebecca Raeside, Rui Han, Allyson Todd, Sara Wardak, Stephanie Partridge

Background: Improving nutrition and physical activity behaviours depends on access to age-appropriate support. Chatbots – software programs designed to simulate conversations with human users – have the potential to deliver support to adolescents to improve health behaviours, but feasibility and acceptability of chatbots in adolescents is unknown.

Aims: To evaluate the feasibility and acceptability of chatbots in nutrition and physical activity interventions among adolescents. Secondly, to consult adolescents to identify features of chatbots that are acceptable and feasible.

Methods: Inclusion criteria were (i) participants 10-19 years; (ii) without chronic disease except obesity/type 2 diabetes; (iii) assessed chatbots in nutrition and/or physical activity interventions. Data were presented in a narrative summary. Results were presented to a diverse group of adolescents to identify feasible and acceptable features and gain insights beyond what is published in the literature.

Results: Six electronic databases were searched with five studies included, evaluating five unique chatbots, focusing on nutrition (n=2), physical activity (n=2) and both (n=1). All were supported by mobile applications using a combination of design features (personalised feedback, conversational agents, gamification, monitoring behaviour change). Usage rates were >50% in 3/5 studies. Three studies reported health-related outcomes with one showing promising effects. Adolescent consultation identified novel concerns around chatbot use including ethical concerns and false or misleading information being used.

Conclusions: Limited research is available on chatbots in adolescent nutrition and physical activity interventions, showing low usage rates and insignificant effects. Chatbot design must be reviewed to ensure higher levels of acceptability and feasibility in an adolescent population.