A multilingual digital mental health and wellbeing chatbot (ChatPal): pre-post multicenter intervention study

Courtney Potts, Frida Lindstrom, RR Bond, Maurice Mulvenna, Frederick Booth, Edel Ennis, Karolina Parding, Catrine Kostenius, Thomas Broderick, Kyle Boyd, Anna-Kaisa Vartiainen, Heidi Nieminen, Con Burns, Andrea Bickerdike, Lauri Kousmanen, Indika S. A. Dhanapala, Alex Vakaloudis, Brian Cahill, Marion MacInnes, Martin MalcolmSiobhan O'Neill

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Background: In recent years, advances in technology have led to an influx of mental health apps, in particular the development of mental health and wellbeing chatbots which have already shown promise in terms of their efficacy, availability and accessibility. The ChatPal chatbot was developed to promote positive mental wellbeing amongst citizens living in rural areas. ChatPal is a multilingual chatbot, available in English, Scottish Gaelic, Swedish and Finnish, containing psychoeducational content and exercises such as mindfulness and breathing, mood logging, gratitude, and thoughts diaries.
Objective: The primary objective of this study is evaluate a multilingual mental health and wellbeing chatbot (ChatPal) to establish if it has an effect on mental wellbeing. Secondary objectives include investigating the characteristics of individuals that showed improvements in wellbeing along with those with worsening wellbeing and applying thematic analysis to user feedback.
Methods: A pre-post intervention study was conducted where participants were recruited to use the intervention (ChatPal) for a 12-week period. Recruitment took place across five regions: Northern Ireland, Scotland, Republic of Ireland, Sweden and Finland. Outcome measures included the Short Warwick Edinburgh Mental Wellbeing Scale, World Health Organisation-Five Well-Being Index, and Satisfaction with Life Scale were evaluated at baseline, midpoint, and endpoint. Written feedback was collected from participants and subjected to qualitative analysis to identify themes.
Results: A total of 348 people were recruited to the study (75% female, 25% male) aged between 18-73 (mean age 30). The wellbeing scores of participants improved from baseline to midpoint and from baseline to end-point, however improvement in scores were not statistically significant on the Short Warwick Edinburgh Mental Wellbeing Scale (P=.42), World Health Organisation-Five Well-Being Index (P=.52), or Satisfaction with Life Scale (P=.81). Individuals that had improved wellbeing scores (n=16) interacted more with the chatbot and were significantly younger compared to those whose wellbeing declined over the study (P=.025). Three themes were identified from user feedback including ‘positive experiences’, ‘mixed/ neutral experiences’ and ‘negative experiences’. Positive experiences included enjoying exercises provided by the chatbot, while most of the mixed/ neutral or negative experiences mentioned liking the chatbot overall, but that there were some barriers, such as technical or performance errors which needed to be overcome.
Conclusions: Marginal improvements in mental wellbeing were seen in those who used ChatPal, albeit non-significant. We propose that the chatbot could be used along with other service offerings to complement different digital or face-to-face services, although further research should be carried out to confirm the effectiveness of this approach. Nonetheless, this paper highlights the need for blended service offerings in mental health care.
Original languageEnglish
JournalJournal of Medical Internet Research
Publication statusAccepted/In press - 31 Jan 2023


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