Virtual Humans in Health-Related Interventions: A Meta-Analysis
Abstract
Virtual humans are computer-generated characters designed to simulate key properties of human face-to-face conversation---verbal and nonverbal. Their human-like physical appearance and nonverbal behavior set them apart from chatbot-type embodied conversational agents, and has recently received significant interest as a potential tool for health-related interventions. As healthcare providers deliberate whether to adopt this new technology, it is crucial to examine the empirical evidence about their effectiveness. We systematically evaluated evidence from controlled studies of interventions using virtual humans on their effectiveness in health-related outcomes. Nineteen studies were included from a total of 3354 unique records. Although study objectives varied greatly, most targeted psychological conditions, such as mood, anxiety, and autism spectrum disorders (ASD). Virtual humans demonstrated effectiveness in improving health-related outcomes, more strongly when targeting clinical conditions, such as ASD or pain management, than general wellness, such as weight loss. We discuss the emerging differences when designing for clinical interventions versus wellness.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The MAX conversational agent is the first (to the best of our knowledge) conversational agent that takes over the role of a scalable social actor framed as a scalable assistant of a health care professional that mediates communication among various relevant stakeholders in the context of chronic disease management.
“the current conversational agent is the first (to the best of our knowledge) that takes over the role of a scalable social actor framed as a scalable assistant of a health care professional that mediates communication among various relevant stakeholders in the context of chronic disease management.”
Cites
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA Group* (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00135 · Cited by 37,554 · see citing works
Embodied conversational agents in clinical psychology: a scoping review
Provoost, S., Lau, H. M., Ruwaard, J., & Riper, H. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6553 · Cited by 433 · see citing works
Craig, T. K., Rus-Calafell, M., Ward, T., Leff, J. P., Huckvale, M., Howarth, E., Emsley, R., & Garety, P. A. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30427-3 · Cited by 403 · cited 3× · see citing works
“Some Characteristics of Selected Studies exclusively women as participants: 2 [1, 7] exclusively children as participants: 2 [2, 19] exclusively older adults as participants: 1 [9] example of clinical conditions: overactive bladder (OAB) [1], depression [4], schizophrenia [5, 11], substance abuse [8], ASD [9], termina…”
BackgroundLy, K. H., Ly, A.-M., & Andersson, G. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.10.002 · Cited by 368 · see citing works
Hopkins, I. M., Gower, M. W., Perez, T. A., Smith, D. S., Amthor, F. R., Wimsatt, F. C., & Biasini, F. J. (2011) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-011-1179-z · Cited by 342 · see citing works
A randomized controlled trial of an automated exercise coach for older adults
Bickmore, T. W., Silliman, R. A., Nelson, K., Cheng, D. M., Winter, M., Henault, L., & Paasche‐Orlow, M. K. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12449 · Cited by 305 · cited 5× · see citing works
“Some Characteristics of Selected Studies exclusively women as participants: 2 [1, 7] exclusively children as participants: 2 [2, 19] exclusively older adults as participants: 1 [9] example of clinical conditions: overactive bladder (OAB) [1], depression [4], schizophrenia [5, 11], substance abuse [8], ASD [9], termina…”
BackgroundInfluentialWhat is your research question? An introduction to the PICOT format for clinicians.
(2012) · Europe PMC (PubMed Central) · Cited by 295 · see citing works
Park, K., Ku, J. H., Choi, S., Jang, H.-J., Park, J., Kim, S. I., & Kim, J. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2011.04.003 · Cited by 256 · see citing works
Computer-assisted therapy for medication-resistant auditory hallucinations: proof-of-concept study
Leff, J., Williams, G., Huckvale, M. A., Arbuthnott, M., & Leff, A. P. (2013) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.124883 · Cited by 200 · see citing works
Bickmore, T. W., Utami, D., Matsuyama, R., & Paasche-Orlow, M. K. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5239 · Cited by 153 · see citing works
Gardiner, P. M., McCue, K. D., Negash, L. M., Cheng, T., White, L. F., Yinusa-Nyahkoon, L., Jack, B. W., & Bickmore, T. W. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.04.015 · Cited by 139 · see citing works
Burton, C., Szentagotai Tatar, A., McKinstry, B., Matheson, C., Matu, S., Moldovan, R., Macnab, M., Farrow, E., David, D., Pagliari, C., et al. (2016) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x15609793 · Cited by 125 · see citing works
Friederichs, S., Bolman, C., Oenema, A., Guyaux, J., & Lechner, L. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.2974 · Cited by 69 · see citing works
Andrade, A. D., Anam, R., Karanam, C., Downey, P. A., & Ruiz, J. G. (2015) · Urology · doi:10.1016/j.urology.2014.11.017 · Cited by 41 · see citing works
Im, H., Ku, J., Kim, H. J., & Kang, Y. J. (2016) · Annals of Rehabilitation Medicine · doi:10.5535/arm.2016.40.3.420 · Cited by 36 · see citing works
Augmenting Group Medical Visits with Conversational Agents for Stress Management Behavior Change
Shamekhi, A., Bickmore, T., Lessios, A. S., & Gardiner, P. M. (2017) · Lecture notes in computer science · doi:10.1007/978-3-319-55134-0_5 · Cited by 35 · see citing works
Talk About Death: End of Life Planning with a Virtual Agent
Utami, D., Bickmore, T., Nikolopoulou, A. I., & Paasche‐Orlow, M. K. (2017) · Lecture notes in computer science · doi:10.1007/978-3-319-67401-8_55 · Cited by 34 · see citing works
Gordon, M., Carswell, S. B., Schadegg, M. J., Mangen, K., Merkel, K., Tangires, S., & Vocci, F. J. (2017) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2017.1280816 · Cited by 25 · see citing works
Ruiz, J. G., Andrade, A. D., Anam, R., Lisigurski, M. Z., Karanam, C., & Sharit, J. (2013) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721713508825 · Cited by 16 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Hauser-Ulrich, S., Künzli, H., Meier-Peterhans, D., & Kowatsch, T. (2020) · JMIR mHealth and uHealth · doi:10.2196/15806 · Cited by 210 · see citing works
He, Y., Yang, L., Qian, C., Li, T., Su, Z., Zhang, Q., & Hou, X. (2023) · Journal of Medical Internet Research · doi:10.2196/43862 · Cited by 213 · see citing works
He, Y., Yang, L., Zhu, X., Wu, B., Zhang, S., Qian, C., & Tian, T. (2022) · Journal of Medical Internet Research · doi:10.2196/40719 · Cited by 178 · see citing works
Chatbots to Support Young Adults’ Mental Health: An Exploratory Study of Acceptability
Koulouri, T., Macredie, R. D., & Olakitan, D. (2022) · ACM Transactions on Interactive Intelligent Systems · doi:10.1145/3485874 · Cited by 127 · see citing works
Kowatsch, T., Schachner, T., Harperink, S., Barata, F., Dittler, U., Xiao, G., Stanger, C., v Wangenheim, F., Fleisch, E., Oswald, H., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/25060 · Cited by 103 · see citing works
A Meta-Analysis of Human Personality and Robot Acceptance in Human-Robot Interaction
Esterwood, C. T., Essenmacher, K., Yang, H., Zeng, F., & Robert, L. (2021) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3411764.3445542 · Cited by 89 · see citing works
Scale-up of Digital Innovations in Health Care: Expert Commentary on Enablers and Barriers
Schlieter, H., Marsch, L. A., Whitehouse, D., Otto, L., Londral, A. R. M., Teepe, G. W., Benedict, M., Ollier, J., Ulmer, T., Gasser, N., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/24582 · Cited by 88 · see citing works
Keller, R., Hartmann, S., Teepe, G. W., Lohse, K.-M., Alattas, A., Car, L. T., Müller‐Riemenschneider, F., von Wangenheim, F., Mair, J. L., & Kowatsch, T. (2021) · Journal of Medical Internet Research · doi:10.2196/33348 · Cited by 43 · see citing works
He, L., Balaji, D., Wiers, R. W. H. J., Antheunis, M. L., & Krahmer, E. (2022) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntac281 · Cited by 49 · see citing works
Issom, D.-Z., Hardy-Dessources, M.-D., Romana, M., Hartvigsen, G., & Lovis, C. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2021.600333 · Cited by 39 · see citing works
Kowatsch, T., Lohse, K.-M., Erb, V., Schittenhelm, L., Galliker, H., Lehner, R., & Huang, E. M. (2021) · Journal of Medical Internet Research · doi:10.2196/23612 · Cited by 39 · see citing works
Tailoring coaching strategies to users’ motivation in a multi-agent health coaching application
Beinema, T. C., den Akker, H. O., van Velsen, L., & Hermens, H. J. (2021) · Computers in Human Behavior · doi:10.1016/j.chb.2021.106787 · Cited by 38 · see citing works
Hauser-Ulrich, S., Lienhard, N., Künzli, H., & Kowatsch, T. (2024) · JMIR mhealth and uhealth · doi:10.2196/54945 · Cited by 49 · see citing works
Ollier, J., Neff, S., Dworschak, C., Sejdiji, A., Santhanam, P., Keller, R., Xiao, G., Asisof, A., Rüegger, D., Bérubé, C., et al. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.625640 · Cited by 28 · see citing works
Gross, C., Schachner, T., Hasl, A., Kohlbrenner, D., Clarenbach, C. F., von Wangenheim, F., & Kowatsch, T. (2021) · Journal of Medical Internet Research · doi:10.2196/26643 · Cited by 23 · see citing works
A Meta-Analysis of Human Personality and Robot Acceptance in Human-Robot InteractionPreprint
Esterwood, C. T., Essenmacher, K., Yang, H., Zeng, F., & Robert, L. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3768022 · Cited by 17 · see citing works
Conversational Agents for Health and Well-being Across the Life Course: Protocol for an Evidence Map
Guerreiro, M. P., Angelini, L., Henriques, H. R., Kamali, M. E., Baixinho, C. L., Balsa, J., Félix, I. B., Khaled, O. A., Carmo, M. B., Cláudio, A. P., et al. (2021) · JMIR Research Protocols · doi:10.2196/26680 · Cited by 13 · see citing works
Virtual human pose estimation in a fire education system for children with autism spectrum disorders
Guo, Y., Liu, H., Sun, Y., & Ren, Y. (2024) · Multimedia Systems · doi:10.1007/s00530-024-01274-3 · Cited by 11 · see citing works
A Meta-Analysis of Effect Sizes of CHI Typing Experiments
Obukhova, N. (2021) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3411763.3451520 · Cited by 8 · see citing works
Schachner, T., Gross, C., Hasl, A., von Wangenheim, F., & Kowatsch, T. (2020) · Journal of Medical Internet Research · doi:10.2196/22919 · Cited by 7 · see citing works
Technical challenges to deliver sensor-based psychological interventions using smartphones
González‐Pérez, A., Miralles, I., Granell, C., & Casteleyn, S. (2019) · ACM International Joint Conference on Pervasive and Ubiquitous Computing (UbiComp) · doi:10.1145/3341162.3346271 · Cited by 6 · see citing works
The Passive Sensing Agent: A Multimodal Adaptive mHealth Application
Mozgai, S., Hartholt, A., & Rizzo, A. (2020) · IEEE International Conference on Pervasive Computing and Communications Workshops (PerCom Workshops) · doi:10.1109/percomworkshops48775.2020.9156177 · Cited by 6 · see citing works
Hyams, T. C., Golden, B., Sammarco, J., Sultan, S., King‐Marshall, E., Wang, M. Q., & Curbow, B. A. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06705-9 · Cited by 6 · see citing works
Keller, R., Yao, J., Teepe, G. W., Hartmann, S., Lohse, K.-M., von Wangenheim, F., Müller‐Riemenschneider, F., Mair, J. L., & Kowatsch, T. (2021) · International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC) · doi:10.5220/0010412708110816 · Cited by 4 · see citing works
He, Y., Yang, L., Zhu, X., Wu, B., Zhang, S., Qian, C., & Tian, T. (2022) · doi:10.2196/preprints.40719 · Cited by 3 · see citing works
Digital Humans for Depression Assessment and Intervention Support: Scoping Review
Cao, J., Gao, W., Wen, R., Li, C., Hoermann, S., Baghaei, N., & Billinghurst, M. (2025) · JMIR Mental Health · doi:10.2196/79954 · Cited by 3 · see citing works
Lim, S., Yang, Q., Meng, J., & Rains, S. A. (2025) · Behaviour and Information Technology · doi:10.1080/0144929x.2025.2567989 · Cited by 3 · see citing works
Fey, M., Peperkorn, N., Borchert, T., Meyer, M. L., Raacke, J., & Shiban, Y. (2023) · International Journal of Cognitive Therapy · doi:10.1007/s41811-023-00186-w · Cited by 3 · see citing works
Marcoux, A., Tessier, M.-H., Grondin, F., Reduron, L. R., & Jackson, P. L. (2021) · Santé mentale au Québec · doi:10.7202/1081509ar · Cited by 4 · see citing works
Non-pharmacological interventions for children on the autism spectrum: An umbrella reviewPreprint
Trembath, D. L., Varcin, K. J., Waddington, H. L., Sulek, R., Bent, C. A., Ashburner, J. K., Eapen, V., Goodall, E., Hudry, K., Roberts, J., et al. (2021) · doi:10.31234/osf.io/yuncj · Cited by 3 · see citing works
Toward a Scoping Review of Social Intelligence in Virtual Humans
Mozgai, S., Beland, S., Leeds, A., Winn, J. G., Kaurloto, C., Heylen, D., & Hartholt, A. (2023) · International Conference on Automatic Face and Gesture Recognition · doi:10.1109/fg57933.2023.10042532 · Cited by 1 · see citing works
Pickering, I., Law, M., Loveys, K., Sagar, M. A., Skoluda, N., Nater, U. M., & Broadbent, E. (2025) · Multimodal Technologies and Interaction · doi:10.3390/mti9040034
Ulrich, S., Lienhard, N., Künzli, H., & Kowatsch, T. (2024) · Zürcher Hochschule für Angewandte Wissenschaften digital collection (Zurich University of Applied Sciences) · doi:10.21256/zhaw-30977
Hyams, T. C., Golden, B., Sammarco, J. J., Sultan, S., King‐Marshall, E., Wang, M. Q., & Curbow, B. A. (2021) · Figshare · doi:10.6084/m9.figshare.15079843
A Narrative Review of Virtual Human Twins (VHTs) of Healthcare Professionals
Gargiulo, L., Saritas, S. N., Arar, F. E., Saitta, L., de Luca, M., Vallefuoco, E., Arlati, S., Mondellini, M., Moccaldi, N., d'Errico, G., et al. (2025) · IEEE International Conference on Metrology for eXtended Reality, Artificial Intelligence and Neural Engineering (MetroXRAINE) · doi:10.1109/metroxraine66377.2025.11340559
Breathe and Relax: An Alexa-Based Voice Intervention for Stress Reduction and Emotional Well-Being
Gallegos, E., Ávila, D., Reinoso, J., Guerrero, G., & Ortiz, G. (2026) · Communications in computer and information science · doi:10.1007/978-3-032-16761-3_16
Virtual Humans: A Survey of Technologies and Applications
Xu, Y., Zhang, W., Liu, Y., & Liu, J. (2025) · International Conference on Vision, Image and Signal Processing (ICVISP) · doi:10.1109/icvisp68610.2025.11451745
- Authors
- Ma, T., Sharifi, H., & Chattopadhyay, D.
- Affiliations
- University of Illinois Chicago (US)
- Venue
- Extended Abstracts of the 2019 CHI Conference on Human Factors in Computing Systems
- Publisher
- ACM
- Published
- 2019-05-02
- Pages
- 1-6
- OpenAlex
- W2942811502
- Cited by
- 37
- References
- 19
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 17 · 2020: 3 · 2019: 1
- FWCI
- 10.32
- Type
- conference paper
- Language
- en
- Open access
- closed
- Locations
- CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Keywords
- virtual humans, embodied conversational agents, health interventions, nonverbal behavior, autism spectrum disorder, pain management, mood, anxiety, weight loss, health technology adoption
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
