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Chatbots are intelligent conversational computer systems designed to mimic human conversation to enable automated online guidance and support. The increased benefits of chatbots led to their wide adoption by many industries in order to provide virtual assistance to customers. Chatbots utilise methods and algorithms from two Artificial Intelligence domains: Natural Language Processing and Machine Learning. However, there are many challenges and limitations in their application. In this survey we review recent advances on chatbots, where Artificial Intelligence and Natural Language processing are used. We highlight the main challenges and limitations of current work and make recommendations for future research investigation.

Question answering (QA) systems provide a way of querying the information available in various formats including, but not limited to, unstructured and structured data in natural languages. It constitutes a considerable part of conversational artificial intelligence (AI) which has led to the introduction of a special research topic on conversational question answering (CQA), wherein a system is required to understand the given context and then engages in multi-turn QA to satisfy a user’s information needs. While the focus of most of the existing research work is subjected to single-turn QA, the field of multi-turn QA has recently grasped attention and prominence owing to the availability of large-scale, multi-turn QA datasets and the development of pre-trained language models. With a good amount of models and research papers adding to the literature every year recently, there is a dire need of arranging and presenting the related work in a unified manner to streamline future research. This survey is an effort to present a comprehensive review of the state-of-the-art research trends of CQA primarily based on reviewed papers over the recent years. Our findings show that there has been a trend shift from single-turn to multi-turn QA which empowers the field of Conversational AI from different perspectives. This survey is intended to provide an epitome for the research community with the hope of laying a strong foundation for the field of CQA.

Large-scale language technologies are increasingly used in various forms of communication with humans across different contexts. One particular use case for these technologies is conversational agents, which output natural language text in response to prompts and queries. This mode of engagement raises a number of social and ethical questions. For example, what does it mean to align conversational agents with human norms or values? Which norms or values should they be aligned with? And how can this be accomplished? In this paper, we propose a number of steps that help answer these questions. We start by developing a philosophical analysis of the building blocks of linguistic communication between conversational agents and human interlocutors. We then use this analysis to identify and formulate ideal norms of conversation that can govern successful linguistic communication between humans and conversational agents. Furthermore, we explore how these norms can be used to align conversational agents with human values across a range of different discursive domains. We conclude by discussing the practical implications of our proposal for the design of conversational agents that are aligned with these norms and values.

Prompt engineering is a relatively new field of research that refers to the practice of designing, refining, and implementing prompts or instructions that guide the output of large language models (LLMs) to help in various tasks. With the emergence of LLMs, the most popular one being ChatGPT that has attracted the attention of over a 100 million users in only 2 months, artificial intelligence (AI), especially generative AI, has become accessible for the masses. This is an unprecedented paradigm shift not only because of the use of AI becoming more widespread but also due to the possible implications of LLMs in health care. As more patients and medical professionals use AI-based tools, LLMs being the most popular representatives of that group, it seems inevitable to address the challenge to improve this skill. This paper summarizes the current state of research about prompt engineering and, at the same time, aims at providing practical recommendations for the wide range of health care professionals to improve their interactions with LLMs.

Chatbots have become common in digital customer service contexts across many industries. While many companies choose to humanize their customer service chatbots (e.g., giving them names and avatars), little is known about how anthropomorphism influences customer responses to chatbots in service settings. Across five studies, including an analysis of a large real-world data set from an international telecommunications company and four experiments, the authors find that when customers enter a chatbot-led service interaction in an angry emotional state, chatbot anthropomorphism has a negative effect on customer satisfaction, overall firm evaluation, and subsequent purchase intentions. However, this is not the case for customers in nonangry emotional states. The authors uncover the underlying mechanism driving this negative effect (expectancy violations caused by inflated pre-encounter expectations of chatbot efficacy) and offer practical implications for managers. These findings suggest that it is important to both carefully design chatbots and consider the emotional context in which they are used, particularly in customer service interactions that involve resolving problems or handling complaints.

Chatbots have become ubiquitous in our daily lives, enabling natural language conversations with users through various modes of communication. Chatbots have the potential to play a significant role in promoting health and well-being. As the number of studies and available products related to chatbots continues to rise, there is a critical need to assess product features to enhance the design of chatbots that effectively promote health and behavioral change. This scoping review aims to provide a comprehensive assessment of the current state of health-related chatbots, including the chatbots' characteristics and features, user backgrounds, communication models, relational building capacity, personalization, interaction, responses to suicidal thoughts, and users' in-app experiences during chatbot use. Through this analysis, we seek to identify gaps in the current research, guide future directions, and enhance the design of health-focused chatbots. Following the scoping review methodology by Arksey and O'Malley and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, this study used a two-pronged approach to identify relevant chatbots: (1) searching the iOS and Android App Stores and (2) reviewing scientific literature through a search strategy designed by a librarian. Overall, 36 chatbots were selected based on predefined criteria from both sources. These chatbots were systematically evaluated using a comprehensive framework developed for this study, including chatbot characteristics, user backgrounds, building relational capacity, personalization, interaction models, responses to critical situations, and user experiences. Ten coauthors were responsible for downloading and testing the chatbots, coding their features, and evaluating their performance in simulated conversations. The testing of all chatbot apps was limited to their free-to-use features. This review provides an overview of the diversity of health-related chatbots, encompassing categories such as mental health support, physical activity promotion, and behavior change interventions. Chatbots use text, animations, speech, images, and emojis for communication. The findings highlight variations in conversational capabilities, including empathy, humor, and personalization. Notably, concerns regarding safety, particularly in addressing suicidal thoughts, were evident. Approximately 44% (16/36) of the chatbots effectively addressed suicidal thoughts. User experiences and behavioral outcomes demonstrated the potential of chatbots in health interventions, but evidence remains limited. This scoping review underscores the significance of chatbots in health-related applications and offers insights into their features, functionalities, and user experiences. This study contributes to advancing the understanding of chatbots' role in digital health interventions, thus paving the way for more effective and user-centric health promotion strategies. This study informs future research directions, emphasizing the need for rigorous randomized control trials, standardized evaluation metrics, and user-centered design to unlock the full potential of chatbots in enhancing health and well-being. Future research should focus on addressing limitations, exploring real-world user experiences, and implementing robust data security and privacy measures.

Chatbots, or conversational agents, have emerged as significant tools in health care, driven by advancements in artificial intelligence and digital technology. These programs are designed to simulate human conversations, addressing various health care needs. However, no comprehensive synthesis of health care chatbots' roles, users, benefits, and limitations is available to inform future research and application in the field. This review aims to describe health care chatbots' characteristics, focusing on their diverse roles in the health care pathway, user groups, benefits, and limitations. A rapid review of published literature from 2017 to 2023 was performed with a search strategy developed in collaboration with a health sciences librarian and implemented in the MEDLINE and Embase databases. Primary research studies reporting on chatbot roles or benefits in health care were included. Two reviewers dual-screened the search results. Extracted data on chatbot roles, users, benefits, and limitations were subjected to content analysis. The review categorized chatbot roles into 2 themes: delivery of remote health services, including patient support, care management, education, skills building, and health behavior promotion, and provision of administrative assistance to health care providers. User groups spanned across patients with chronic conditions as well as patients with cancer; individuals focused on lifestyle improvements; and various demographic groups such as women, families, and older adults. Professionals and students in health care also emerged as significant users, alongside groups seeking mental health support, behavioral change, and educational enhancement. The benefits of health care chatbots were also classified into 2 themes: improvement of health care quality and efficiency and cost-effectiveness in health care delivery. The identified limitations encompassed ethical challenges, medicolegal and safety concerns, technical difficulties, user experience issues, and societal and economic impacts. Health care chatbots offer a wide spectrum of applications, potentially impacting various aspects of health care. While they are promising tools for improving health care efficiency and quality, their integration into the health care system must be approached with consideration of their limitations to ensure optimal, safe, and equitable use.

ChatGPT-4 is the latest release of a novel artificial intelligence (AI) chatbot able to answer freely formulated and complex questions. In the near future, ChatGPT could become the new standard for health care professionals and patients to access medical information. However, little is known about the quality of medical information provided by the AI. We aimed to assess the reliability of medical information provided by ChatGPT. Medical information provided by ChatGPT-4 on the 5 hepato-pancreatico-biliary (HPB) conditions with the highest global disease burden was measured with the Ensuring Quality Information for Patients (EQIP) tool. The EQIP tool is used to measure the quality of internet-available information and consists of 36 items that are divided into 3 subsections. In addition, 5 guideline recommendations per analyzed condition were rephrased as questions and input to ChatGPT, and agreement between the guidelines and the AI answer was measured by 2 authors independently. All queries were repeated 3 times to measure the internal consistency of ChatGPT. Five conditions were identified (gallstone disease, pancreatitis, liver cirrhosis, pancreatic cancer, and hepatocellular carcinoma). The median EQIP score across all conditions was 16 (IQR 14.5-18) for the total of 36 items. Divided by subsection, median scores for content, identification, and structure data were 10 (IQR 9.5-12.5), 1 (IQR 1-1), and 4 (IQR 4-5), respectively. Agreement between guideline recommendations and answers provided by ChatGPT was 60% (15/25). Interrater agreement as measured by the Fleiss κ was 0.78 (P<.001), indicating substantial agreement. Internal consistency of the answers provided by ChatGPT was 100%. ChatGPT provides medical information of comparable quality to available static internet information. Although currently of limited quality, large language models could become the future standard for patients and health care professionals to gather medical information.

The personalization of conversational agents with natural language user interfaces is seeing increasing use in health care applications, shaping the content, structure, or purpose of the dialogue between humans and conversational agents. The goal of this systematic review was to understand the ways in which personalization has been used with conversational agents in health care and characterize the methods of its implementation. We searched on PubMed, Embase, CINAHL, PsycInfo, and ACM Digital Library using a predefined search strategy. The studies were included if they: (1) were primary research studies that focused on consumers, caregivers, or health care professionals; (2) involved a conversational agent with an unconstrained natural language interface; (3) tested the system with human subjects; and (4) implemented personalization features. The search found 1958 publications. After abstract and full-text screening, 13 studies were included in the review. Common examples of personalized content included feedback, daily health reports, alerts, warnings, and recommendations. The personalization features were implemented without a theoretical framework of customization and with limited evaluation of its impact. While conversational agents with personalization features were reported to improve user satisfaction, user engagement and dialogue quality, the role of personalization in improving health outcomes was not assessed directly. Most of the studies in our review implemented the personalization features without theoretical or evidence-based support for them and did not leverage the recent developments in other domains of personalization. Future research could incorporate personalization as a distinct design factor with a more careful consideration of its impact on health outcomes and its implications on patient safety, privacy, and decision-making.

Artificial intelligence (AI) conversational agents (CA) or chatbots represent one of the technologies that can provide automated customer service for companies, a trend encountered in recent years. Chatbot use is beneficial for companies when associated with positive customer experience. The purpose of this paper is to analyze the overall customer experience with customer service chatbots in order to identify the main influencing factors for customer experience with customer service chatbots and to identify the resulting dimensions of customer experience (such as perceptions/attitudes and feelings and also responses and behaviors). The analysis uses the systematic literature review (SLR) method and includes a sample of 40 publications that present empirical studies. The results illustrate that the main influencing factors of customer experience with chatbots are grouped in three categories: chatbot-related, customer-related, and context-related factors, where the chatbot-related factors are further categorized in: functional features of chatbots, system features of chatbots and anthropomorphic features of chatbots. The multitude of factors of customer experience result in either positive or negative perceptions/attitudes and feelings of customers. At the same time, customers respond by manifesting their intentions and/or their behaviors towards either the technology itself (chatbot usage continuation and acceptance of chatbot recommendations) or towards the company (buying and recommending products). According to empirical studies, the most influential factors when using chatbots for customer service are response relevance and problem resolution, which usually result in positive customer satisfaction, increased probability for chatbots usage continuation, product purchases, and product recommendations.