Recommendations for Mental Health Chatbot Conversations: An Integrative Review

Aim: To identify and synthesise recommendations and guidelines for mental health chatbot conversational design. Design: Integrative review. Methods: Suitable publications presenting recommendations or guidelines for mental health conversational design were included. The quality of included publications was assessed using Joanna Briggs Institute Critical Appraisal Tools. Thematic analysis was conducted. Data sources: Primary searches limited to last 10 years were conducted in PubMed, Scopus, ACM Digital Library and EBSCO databases including APA PsycINFO, CINAHL, APA PsycArticles and MEDLINE in February 2023 and updated in October 2023. A secondary search was conducted in Google Scholar in May 2023. Results: Of 1684 articles screened, 16 publications were selected. Three overarching themes were developed: (1) explicit knowledge about chatbot design and domain, (2) knowing your audience and (3) creating a safe space to engage. Results highlight that creating pleasant and effective conversations with a mental health chatbot requires careful and professional planning in advance, defining the target group and working together with it to address its needs and preferences. It is essential to emphasise the pleasant user experience and safety from both technical and psychological perspectives. Conclusion: Recommendations for mental health chatbot conversational design have evolved and become more specific in recent years. Recommendations set high standards for mental health chatbots. To meet that, co‐design, explicit knowledge of the user needs, domain and conversational design is needed. Implications for the Profession and/or Patient Care: Mental health professionals participating in chatbot development can utilise this review. The results can also inform technical development teams not involving healthcare professionals directly. Impact: Knowledge of developing mental health chatbot conversations appears scattered. In mental health chatbots, features that enhance the chatbot's ability to meet users' needs and increase safety should be considered. This review is useful for developers of mental health chatbots and other health applications used independently. Reporting Method: This integrative review was reported according to PRISMA guidelines, as applicable. Patient or Public Contribution: No patient or public contribution.