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Cited by 267Digital Mental Health InterventionsCancer survivorship and careMobile Health and mHealth Applications

Use of the Chatbot “Vivibot” to Deliver Positive Psychology Skills and Promote Well-Being Among Young People After Cancer Treatment: Randomized Controlled Feasibility Trial

Open access
Greer, Stephanie, Ramo, Danielle, Chang, Yin-Juei, Fu, Michael, Moskowitz, Judith, Haritatos, Jana·2019·JMIR mHealth and uHealth
DOI 10.2196/15018PMC PMC6913733

Published version of a preprint

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Abstract

Background: Positive psychology interventions show promise for reducing psychosocial distress associated with health adversity and have the potential to be widely disseminated to young adults through technology. Objective: This pilot randomized controlled trial examined the feasibility of delivering positive psychology skills via the Vivibot chatbot and its effects on key psychosocial well-being outcomes in young adults treated for cancer. Methods: Young adults (age 18-29 years) were recruited within 5 years of completing active cancer treatment by using the Vivibot chatbot on Facebook messenger. Participants were randomized to either immediate access to Vivibot content (experimental group) or access to only daily emotion ratings and access to full chatbot content after 4 weeks (control). Created using a human-centered design process with young adults treated for cancer, Vivibot content includes 4 weeks of positive psychology skills, daily emotion ratings, video, and other material produced by survivors, and periodic feedback check-ins. All participants were assessed for psychosocial well-being via online surveys at baseline and weeks 2, 4, and 8. Analyses examined chatbot engagement and open-ended feedback on likability and perceived helpfulness and compared experimental and control groups with regard to anxiety and depression symptoms and positive and negative emotion changes between baseline and 4 weeks. To verify the main effects, follow-up analyses compared changes in the main outcomes between 4 and 8 weeks in the control group once participants had access to all chatbot content. Results: Data from 45 young adults (36 women; mean age: 25 [SD 2.9]; experimental group: n=25; control group: n=20) were analyzed. Participants in the experimental group spent an average of 74 minutes across an average of 12 active sessions chatting with Vivibot and rated their experience as helpful (mean 2.0/3, SD 0.72) and would recommend it to a friend (mean 6.9/10; SD 2.6). Open-ended feedback noted its nonjudgmental nature as a particular benefit of the chatbot. After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units. A mixed-effects models revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41. Those in the experimental group also experienced greater reductions in anxiety when they engaged in more sessions (z=–1.9, P=.06). There were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion. Conclusions: The chatbot format provides a useful and acceptable way of delivering positive psychology skills to young adults who have undergone cancer treatment and supports anxiety reduction. Further analysis with a larger sample size is required to confirm this pattern.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 4-week pilot randomized controlled trial, the Vivibot chatbot was an engaging and acceptable way to deliver positive psychology skills to young adults after cancer treatment and showed a trend-level reduction in anxiety versus an emotion-rating control. No significant or trend-level group effects were found for depression, positive emotion, or negative emotion, and the authors call for a larger trial.

Key findings

  • Among 45 analyzed participants (36 women; mean age 25, SD 2.9; experimental n=25, control n=20), the experimental group spent an average of 73.8 min (SD 52) across 12.1 engaged sessions (SD 7.1) with Vivibot, while the control group spent 27.13 min (SD 15.8) across 18.1 engaged sessions (SD 8.6) completing daily emotion ratings only. Experimental participants rated Vivibot as helpful (mean 2.03/3, SD 0.72) and would recommend it to a friend (mean 6.9/10, SD 2.6).
  • Anxiety decreased by 2.58 t-score units in the experimental group versus an increase of 0.7 units in the control group, a trend-level group-by-time interaction (z=–1.70; Cohen d=–0.41; P=.09). Greater engagement in sessions was associated with greater anxiety reductions (z=–1.9, P=.06).
  • No significant or trend-level group effects were found for depression (experimental reduction=1.83 vs control reduction=1.38; P=.77), negative emotion (experimental –0.31 vs control –0.23; P=.97), or positive emotion (experimental 0.04 vs control –0.08; P=.82). Daily positive emotion ratings showed a significant interaction in the opposite direction from the hypothesis, with greater increases in the control group (z=–2.07, P=.04).
  • In a post hoc control-group analysis after delayed access to full content, anxiety dropped by 2.72 standardized points from weeks 4 to 8 (P=.13), with no significant depression reduction.

Methods

  • This was a 4-week pilot randomized controlled trial of young adults aged 18-29 years recruited within 5 years of completing active cancer treatment. Recruitment came through Facebook advertising (67% of final sample), survivorship organizations (15%), and direct email (17%); enrollment was managed through the chatbot. Participants were randomized 1:1 to immediate full Vivibot content or to daily emotion ratings only with full access after 4 weeks. Of 51 randomized, 6 control participants were excluded after a technical error gave them full access at 2 weeks, leaving 45 analyzed.
  • Vivibot delivered 28 days of positive psychology content via Facebook Messenger, covering eight skills in seven conversational teaching lessons and seven practice lessons repeated three times, plus daily emotion ratings, survivor-produced video/content, and feedback check-ins. Assessments occurred online at baseline and weeks 2, 4, and 8 using PROMIS 4-item anxiety and depression short forms, a modified Differential Emotions Scale for retrospective positive/negative emotion, and six daily chatbot emotion ratings.
  • Main analyses used multilevel mixed-effects linear models for intention-to-treat, testing condition-by-time interactions for each outcome. Follow-up models examined changes within the control group from weeks 4 to 8 after delayed access, and engagement models tested number of engaged sessions as a predictor. Open-ended feedback was reviewed and quotes selected for prominent themes.

Limitations

  • The paper states that this was a small pilot study not powered to detect significant effects in psychological outcomes, that recruitment of this population is difficult, and that results need replication in a larger sample able to reliably detect a moderate-sized between-group effect.
  • The paper also states that the study was limited to participants willing and able to access Vivibot via Facebook Messenger, that Facebook privacy controversies during the study period may have affected engagement, and that neither cancer type nor stage was considered because analyses collapsed across diagnoses.
  • Evident from the text: follow-up completion was 73% at 2 weeks, 73% at 4 weeks, and 58% at 8 weeks, with significantly lower week-8 completion in the experimental group (44% vs 75%; P=.04); the control condition was active because it included daily emotion ratings, which the authors note may itself have produced benefits and limits isolation of Vivibot-specific effects; and six control participants were excluded after a technical error.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/15018

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 45 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Participants particularly enjoyed the positive psychology content itself.

    “Participants also particularly enjoyed the positive psychology content itself:”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants in the experimental group rated their experience of chatting with Vivibot as helpful, with an average rating of 2.03/3 (SD 0.72).

    “On average, participants in the experimental group rated their experience of chatting with Vivibot as helpful, with an average rating of 2.03/3 (SD 0.72; range: 0-3).”
    Quote in the paperNot a substantial claim
  • Findingown data

    A mixed-effects model revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41.

    “A mixed-effects models revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41.”
    Quote in the paperSubstantial claim
  • Findingown data

    The control group spent an average of 27.13 (SD 15.8) min across an average of 18.1 (SD 8.6) engaged sessions completing the 6-item emotion ratings only.

    “The control group spent an average of 27.13 (SD 15.8) min across an average of 18.1 (SD 8.6) engaged sessions completing the 6-item emotion ratings only.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Open-ended feedback noted the nonjudgmental nature of talking to an automated agent as a particular benefit of the chatbot.

    “Open-ended feedback noted its nonjudgmental nature as a particular benefit of the chatbot.”
    • Also stated in: § Perceived Helpfulness and Open-Ended Feedback. · plain
      “When asked why they were likely or unlikely to recommend Vivibot to a friend, participants remarked on the utility and nonjudgmental nature of talking to an automated agent:”
    Quote in the paperNot a substantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingown data

    After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units.

    “After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion.

    “There were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Participants were on average 2.7 (SD 2.0) years postdiagnosis and 1.6 (SD 1.3) years postcompletion of active cancer treatment.

    “Participants were on average 2.7 (SD 2.0) years postdiagnosis and 1.6 (SD 1.3) years postcompletion of active cancer treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Participants were mostly female (36/45, 80%), with an average age of 25 (SD 2.9; range 19-29 years).

    “Participants were mostly female (36/45, 80%), with an average age of 25 (SD 2.9; range: 19-29 years).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Additional themes in open-ended feedback related to having a shared experience with others who had undergone cancer treatment and being able to just vent.

    “Additional themes related to having a shared experience with others who had undergone cancer treatment and being able to just “vent”:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The rate of follow-up survey completion was 73% at 2 weeks, 73% at 4 weeks, and 58% at 8 weeks.

    “The rate of follow-up survey completion was 73% (33/45) at 2 weeks, 73% (33/45) at 4 weeks, and 58% (26/45) at 8 weeks.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Anecdotally, some users remarked that completing the emotion ratings was helpful to them when asked why they would be willing to refer Vivibot to a friend.

    “Additionally, anecdotally, some users remarked on how completing the emotion ratings was helpful to them when asked why they would be willing to refer Vivibot to a friend”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was a significant interaction by group for daily positive emotion ratings (z=-2.07; P=.04), in the opposite direction from the hypothesis, with the control group showing greater increases than the experimental group.

    “Further, there was a significant interaction by group (z=–2.07; P=.04); however, this effect was in the opposite direction from our hypothesis, as the control group showed greater increases in positive daily emotion ratings reported directly in the chatbot, compared to the experimental group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants in the experimental group reported a greater reduction in anxiety than the control group at a trend level of statistical significance and with a small-to-moderate effect size (experimental reduction 2.58 t-score units vs control 0.7 units; z=-1.70; Cohen d=-0.41; P=.09).

    “Participants in the experimental group reported a greater reduction in anxiety than the control group at a trend level of statistical significance and small-to-moderate effect size (experimental reduction of 2.58 t-score units vs control of 0.7 units; z=–1.70; Cohen d=–0.41; P=.09; Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both experimental and control groups showed a similar magnitude decrease in negative emotion in retrospective ratings from baseline to week 4 (experimental mean difference -0.31, control -0.23), with no significant or trend-level interaction by group at 4 weeks (z=0.23; Cohen d=-0.01; P=.97).

    “Both the experimental group and the control group showed a similar magnitude decrease in negative emotion in retrospective emotion ratings from baseline to week 4 (mean difference: experimental group: –0.31, control group: –0.23), with no significant or trend-level interaction by group for negative emotion at 4 weeks (z=0.23; Cohen d=–0.01; P=.97).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both experimental and control groups showed slight decreases in depressive symptom ratings with no evidence of a condition by time interaction (experimental reduction 1.83; control reduction 1.38; z=0.30; Cohen d=0.09; P=.77).

    “Both experimental and control groups showed slight decreases in depressive symptom ratings with no evidence of a condition by time interaction (experimental reduction=1.83; control reduction=1.38; z=0.30; Cohen d=0.09; P=.77).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Daily emotion ratings recorded in the chatbot showed a significant decrease in negative emotion reporting (z=-2.44; P=.02), but no significant interaction between groups (z=-0.74; P=.46).

    “This pattern was also reflected in the daily emotion ratings recorded in the chatbot, which showed a significant decrease in negative emotion reporting (z=–2.44; P=.02), but no significant interaction between groups (z=–0.74; P=.46).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In a post hoc analysis of the control group (N=17) after receiving access to the full 28-day chatbot content, anxiety symptoms dropped by a similar magnitude (2.72 standardized points) with a statistical trend (P=.13).

    “To validate the results, a post hoc analysis of the change between 4 weeks and 8 weeks in the control group (N=17), after receiving access to the full 28-day chatbot content, revealed a similar magnitude drop in anxiety symptoms (2.72 standardized points) and a statistical trend (P=.13).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At baseline, both the experimental and control groups had moderate anxiety (experimental mean 64.5, SD 6.1; control mean 62.6, SD 7.9; threshold 60) and mild depression (experimental mean 60.1, SD 7.4; control mean 59.0, SD 9.2; threshold 60).

    “At baseline, both experimental and control groups presented with moderate levels of anxiety (experimental group: mean 64.5 [SD 6.1]; control group: mean 62.6 [SD 7.9]; threshold=60) and mild levels of depression (experimental group: mean 60.1 [SD 7.4]; control group: mean 59.0 [SD 9.2]; threshold=60).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Compared to siblings, adolescents and young adults with cancer have poorer overall mental health and are twice as likely to report clinical levels of emotional distress.

    “Compared to their siblings, adolescents and young adults with cancer have reported poorer overall mental health [5] and are twice as likely to report clinical levels of emotional distress [6-8].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [5] source

      Not checked in the free run.

    • cites [6] source

      Not checked in the free run.

    • cites [7] source

      Not checked in the free run.

    • cites [8] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    20%-30% of young people treated for cancer report moderate-to-severe psychological distress lasting into adulthood.

    “Several studies have suggested that 20%-30% of young people treated for cancer report moderate-to-severe psychological distress lasting into adulthood [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The chatbot format provides a useful and acceptable way of delivering positive psychology skills to young adults who have undergone cancer treatment.

    “The chatbot format provides a useful and acceptable way of delivering positive psychology skills to young adults who have undergone cancer treatment and supports anxiety reduction.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 4-week intervention period is sufficient to produce detectable changes in psychosocial well-being outcomes.
    • Rests on an assumption: The control condition (daily emotion ratings only) is an adequate comparator for the experimental condition.
    • Rests on an assumption: Participants' self-reported survey and daily emotion ratings accurately reflect their psychosocial well-being.
    • Rests on an assumption: The chatbot delivered the intended positive psychology content to participants as designed.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The chatbot randomized users 1:1 to one of two groups.

    “The chatbot then randomized users 1:1 to one of two groups: (1) immediate access to the full Vivibot chatbot content (experimental group) or (2) access to daily emotion ratings through Facebook Messenger with delayed full access to the full Vivibot chatbot only after 4 weeks (control group).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The PRISM clinical trial showed statistically significant improvements in patient-reported resilience and cancer-specific quality of life, as well as reduced psychological distress, among adolescents and young adults after cancer treatment aged 12-25 years (N=100).

    “A clinical trial testing the efficacy of the PRISM skills intervention compared to usual care among adolescents and young adults after cancer treatment, aged 12-25 years (N=100), showed statistically significant improvements in patient‐reported resilience and cancer‐specific quality of life, as well as reduced psychological distress [29].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Well-being outcomes were assessed using multilevel mixed-effects linear models for intention to treat.

    “Well-being outcomes were assessed using a series of multilevel mixed-effects linear models for intention to treat.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A set of six participants in the control condition encountered a technical error after the 2-week survey, resulting in access to the full chatbot content at 2 weeks instead of 4 weeks.

    “A set of six participants in the control condition encountered a technical error after the 2-week survey. This resulted in access to the full chatbot content at 2 weeks instead of the full 4 weeks.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    These six participants have been excluded from reported analyses to test outcomes at 4 weeks across a clean sample.

    “These six participants have been excluded from reported analyses to test outcomes at 4 weeks across a clean sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Anxiety is common among young people with cancer, with effective treatments either not available in the settings in which adolescents and young adults with cancer receive treatment or not offered by referring clinicians.

    “Anxiety is also common among young people with cancer, with effective treatments either not available in the settings in which adolescents and young adults with cancer receive treatment or not offered by referring clinicians. [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The experience of a bot-based intervention as nonjudgmental shows promise for future study using this format with young people.

    “The experience of a bot-based intervention as nonjudgmental shows promise for future study using this format with young people.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Due to the unique developmental and psychosocial needs of young people who have been treated for cancer, this investigation collapsed across cancer diagnoses to focus on a more targeted age range.

    “Due to the unique developmental and psychosocial needs of young people who have been treated for cancer, this investigation collapsed across cancer diagnoses to focus on a more targeted age range.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Due to the relatively small population size and heterogeneity of treatment facilities, it is difficult to identify and recruit adolescents and young adults who had completed treatment for cancer for research studies.

    “Due to the relatively small population size and heterogeneity of treatment facilities, it is difficult to identify and recruit adolescents and young adults who had completed treatment for cancer for research studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    This work extends findings showing promise for technology-enabled solutions to address mental health problems.

    “This work extends findings showing promise for technology-enabled solutions to address mental health problems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The anxiety effect size was comparable to that found in a meta-analysis of psychosocial support for cancer (effect size=0.42) and a positive psychology intervention for caregivers (effect size=0.33).

    “Further, it was comparable to that found in a meta-analysis of psychosocial support for cancer (effect size=0.42) [49] and a positive psychology intervention for caregivers (effect size=0.33) [50].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [49] source

      Not checked in the free run.

    • cites [50] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The emotion rating control on its own appeared to carry some benefits for participants, with rating emotions associated with decreased negative emotion and increased positive emotion.

    “The emotion rating control on its own appeared to carry some benefits for participants (rating emotions was associated with decreased negative emotion and increased positive emotion).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The randomized design of this trial extends the promising findings of other positive psychology interventions delivered online and gives confidence that the effect size seen with anxiety is worthy of follow-up.

    “The randomized design of this trial extends the promising findings of other positive psychology interventions delivered online [59] and gives confidence that the effect size seen with anxiety is worthy of follow-up.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Positive emotion, when stimulated through skills-based interventions, is thought to influence health outcomes, both directly and through mediating factors including changing health behaviors, improving physiological functioning, and increasing resources that influence health.

    “Positive emotion, when stimulated through skills-based interventions, is thought to influence health outcomes, both directly and through the mediating influence of factors including changing health behaviors, improving physiological functioning, and increasing resources that influence health [15,46].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] source

      Not checked in the free run.

    • cites [46] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    This was a small pilot study that was not powered to detect significant effects in the psychological outcomes measured.

    “First, this was a small pilot study that was not powered to detect significant effects in the psychological outcomes measured.”
    Quote in the paperSubstantial claim
32 of 32

  • The paper relies on this without support.

    The 4-week intervention period is sufficient to produce detectable changes in psychosocial well-being outcomes.

    “This was a 4-week pilot randomized controlled trial evaluating feasibility, usability, and initial efficacy of the Vivibot chatbot.”
    “After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units.”

  • The paper relies on this without support.

    The control condition (daily emotion ratings only) is an adequate comparator for the experimental condition.

    “Participants were randomized to either immediate access to Vivibot content (experimental group) or access to only daily emotion ratings and access to full chatbot content after 4 weeks (control).”

  • The paper relies on this without support.

    Participants' self-reported survey and daily emotion ratings accurately reflect their psychosocial well-being.

    “All participants were assessed for psychosocial well-being via online surveys at baseline and weeks 2, 4, and 8.”

  • The paper relies on this without support.

    The chatbot delivered the intended positive psychology content to participants as designed.

    “Vivibot is a chatbot designed to deliver prewritten and automatically delivered material to users online via a decision tree structure.”

  • The paper relies on this without support.

    A trend-level (P=.09) interaction is sufficient to support a conclusion of anxiety reduction.

    “A mixed-effects models revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41.”
    “supports anxiety reduction”
5 of 5

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?

  • Greer's Vivibot chatbot leveraged a positive psychology framework to support emotional regulation in young adult cancer survivors, resulting in reduced anxiety and high user satisfaction.

    “Greer’s Vivibot chatbot leveraged a positive psychology framework to support emotional regulation in young adult cancer survivors, resulting in reduced anxiety and high user satisfaction [14].”

    From Empathic AI for Patient-Centered Cancer Care: A Scoping Review of Patient Navigation, Support, and Clinical Practice (2026) · cites this paper as [14]

    The Methods (Intervention Conditions) describe Vivibot’s positive-psychology skills, and the Results report helpfulness ratings and an average reduction in anxiety in the intervention group. However, the between-group anxiety finding was only a nonsignificant trend (P=.09), so “resulting in reduced anxiety” implies a firmer causal finding than this feasibility trial establishes. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The unique emotional needs of teen and young adult patients with cancer were addressed by the delivery of positive psychology skills via the Vivibot chatbot.

    “the unique emotional needs of teen and young adult patients with cancer were addressed by the delivery of positive psychology skills via the Vivibot chatbot [14].”

    From Empathic AI for Patient-Centered Cancer Care: A Scoping Review of Patient Navigation, Support, and Clinical Practice (2026) · cites this paper as [14]

    The Methods (Intervention Conditions) say Vivibot’s content was tailored with input from adolescents and young adults treated for cancer, and the Abstract (Methods) says it delivered positive psychology skills. But the trial enrolled only adults aged 18–29 who had completed treatment; it does not show that the chatbot addressed the needs of teen patients or patients undergoing treatment. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Patients are receptive to receiving education, treatment planning, and emotional support from AI systems.

    “Moreover, the high levels of user satisfaction reported in interventions such as Vivibot [14], Vik [17], Rosa [18], and social media–based studies [193257] underscore that patients are receptive to receiving education, treatment planning, and emotional support from AI systems.”

    From Empathic AI for Patient-Centered Cancer Care: A Scoping Review of Patient Navigation, Support, and Clinical Practice (2026) · cites this paper as [14]

    The Results (Perceived Helpfulness and Open-Ended Feedback; page not provided) report that young people after cancer treatment found Vivibot helpful and valued its nonjudgmental support. The Methods (Intervention Conditions; page not provided) describe lessons in positive psychology skills, but not education about cancer care or treatment planning. The findings therefore support receptivity to this form of emotional support, not the full range of AI services claimed. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • CAs were valuable, informative, and reliable.

    “CAs were valuable, informative, and reliable (Bibault, Chaix, Guillemassé, et al. 2019;Chetlen et al. 2019;Greer et al. 2019;Siglen et al. 2023;Tawfik et al. 2023;Visvanathan et al. 2023).”

    From The Usability and Experience of Artificial Intelligence‐Based Conversational Agents in Health Education for Cancer Patients: A Scoping Review (2026) · cites this paper as Greer et al. 2019

    In Results > Perceived Helpfulness and Open-Ended Feedback (page not provided), participants rated Vivibot as helpful and described its lessons as useful, supporting the claims that it was valuable and informative. The paper does not establish that Vivibot was reliable. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Five studies showed that most patients were satisfied with the information provided by CAs.

    “Five studies showed that most patients were satisfied with the information provided by CAs CAs were valuable, informative, and reliable (Bibault, Chaix, Guillemassé, et al. 2019;Chetlen et al. 2019;Greer et al. 2019;Siglen et al. 2023;Tawfik et al. 2023;Visvanathan et al. 2023).”

    From The Usability and Experience of Artificial Intelligence‐Based Conversational Agents in Health Education for Cancer Patients: A Scoping Review (2026) · cites this paper as Greer et al. 2019

    In Results > Perceived Helpfulness and Open-Ended Feedback (page unavailable), participants rated Vivibot helpful on average and some praised its lessons. The paper does not report that most participants were satisfied with information it provided or that they considered it reliable; its participants were young people after cancer treatment, not patients generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = -1.9reported p = .06 · recomputed p = .057

    “(z=-1.9, p = .06”

  • Consistentz = -0.6reported p = .55 · recomputed p = .549

    “(z=-0.60, p = .55”

2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Averaged emotion ratings cannot have the stated 0-24 range

    Minor

    Each of the three daily items is rated from 0 to 8, so their average ranges from 0 to 8, not 0 to 24. A 0-24 range would apply to their sum.

  • Experimental group's baseline depression is classified below its stated cutoff

    Minor

    The paper calls the experimental group's mean baseline depression mild, although its mean of 60.1 exceeds the stated moderate cutoff of 60.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. SkjuveMBBrandtzægPBChatbots as a new user interface for providing health information to young people2018Social Health Bots https://www.researchgate.net/publication/332859163_Chatbots_as_a_new_user_interface_for_providing_health_information_to_young_people
  2. Ethical and Independent Review Services20102019-05-03Independence, MOEthical and Independent Review Serviceshttp://www.eandireview.com/
  3. 2013, Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), 978

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Related

Authors
Greer, S., Ramo, D., Chang, Y.-J., Fu, M., Moskowitz, J., & Haritatos, J.
Affiliations
  • HopeLab (US)
  • University of California, San Francisco (US)
  • Northwestern University (US)
Corresponding author
Ramo, Danielle
ORCID
Venue
JMIR mHealth and uHealth
Publisher
JMIR Publications Inc.
Published
2019-10-31
Volume
7
Issue
10
Pages
e15018
ISSN
2291-5222 (ISSN-L)
DOI
10.2196/15018
PMC
PMC6913733
OpenAlex
W2975920545
Semantic Scholar
30f0daf859185860c42a66c0a171b94bba92ca6a
Cited by
265
References
58
Citations by year
2026: 37 · 2025: 52 · 2024: 54 · 2023: 45 · 2022: 32 · 2021: 34 · 2020: 10 · 2019: 1
FWCI
21.80
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR mhealth and uhealth (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
chatbots, positive psychology interventions, young adults, cancer survivors, psychosocial well-being, anxiety, depression, emotion regulation, Facebook Messenger, feasibility, digital mental health, survivorship
MeSH terms
Psychology, Positive, Adolescent, Adult, Anxiety, Child Welfare, Depression, Feasibility Studies, Female, Humans, Male, Neoplasms, Pilot Projects, Psychometrics, Surveys and Questionnaires, Survivors

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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 ›

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