Health chatbots in Africa literature: A scoping review (Preprint)

BACKGROUND The primary aim of the literature review was to learn where, and under what circumstances, chatbots have been used effectively for health in Africa, how chatbots have been developed to best effect and how they have been evaluated. A secondary aim was to identify potential lessons and good practices for others chatbots. The review also points to directions for future research on the use of chatbots for health in Africa. OBJECTIVE The aim of this scoping review was to explore and summarize existing literature on the use of chatbots to support and promote health in Africa. METHODS Literature was identified using Google Scholar, EBSCO information services – which includes African health line, PubMed, Medline, PsycInfor, Cochrane databases, Embase, Scopus and Web of Science databases – and other Internet sources (including grey literature). It was conducted between June and July 2021 using a Boolean search method, combining the terms “chatbots” or “virtual assistant” or “conversational agents” or “AI enabled platform” with the terms “health” and “Africa”. RESULTS Published literature on chatbots in Africa’s health space is scant. There is currently no single review exclusively focusing on the topic, and global reviews typically either miss Africa entirely or include a tokenistic single country from the continent. The paucity of studies from Africa highlights a disparity in global research about chatbots and the health sector. Out of almost 221 articles reviewed, only 16 were specifically related to chatbots in Africa. As such this study is one of the first reviews focusing exclusively on literature regarding chatbot use in Africa’s health space. The findings show that research specifically focusing on chatbots is limited. However, the research that does exist mostly centres around infrastructure, uses and user experience – particularly on the design of chatbots that use indigenous languages, or infrastructure that is user-friendly in Africa. For issues pertaining to reach and regulation, research is anchored in issues such as the role of mobile phones in improving access to health services, and on the technology’s ethical implications such as confidentiality and security. Chatbots are viewed as interventions that are potentially highly useful for improving access to health services and information, including support with health concerns and health-promoting behaviours such as fitness. There is a notable lack of studies on gaming and chatbots in Africa, with only one study identified (South Africa). Overall, the results provide a picture of where and how this technology is being used, key successes and challenges, and current gaps. Topics identified as important for the future include further development of voice-activated chatbots, especially those using African dialects; smartphone-based chatbots; further integration of patient needs; new evaluation frameworks, and a better understanding of how to avoid creating or exacerbating issues of equity in health service access. CONCLUSIONS This review concludes that current data is insufficient to show whether chatbots are effectively supporting health in the region. However, it does indicate what kind of chatbot literature is currently available and where gaps are situated, as well as giving direction for future research. It provides insights into popular chatbots and the need to make them accessible through language considerations, platform choice and user trust, as well as the importance of robust evaluation frameworks to assess their impact. There is also a need to extend research on chatbots beyond existing and somewhat limited health disciplines and functions, as well as addressing issues around ethics and inclusivity, especially of users from rural areas and vulnerable populations. There is also a clear need to expand research to new countries on the continent.