Florida Atlantic University researchers have conducted the first scoping review of AI-driven motivational interviewing systems, finding that whilst tools show potential for supporting health behaviour change, few studies rigorously evaluated their impact on actual behaviours or long-term outcomes.
The review, published in the Journal of Medical Internet Research, examined how AI tools such as chatbots and large language models deliver motivational interviewing, a patient-centred counselling method that helps people find their own motivation to change health habits. Motivational interviewing has proven effective across many health care settings, but is not widely used in clinical practice due to limited time, training demands and payment barriers.
The most used AI tools were chatbots, with some virtual agents and mobile apps, using technologies ranging from rule-based systems to advanced models like GPT-3.5 and GPT-4. Only a few studies addressed safety concerns around AI-generated content, with most not detailing safeguards against misinformation or inappropriate responses.
Whilst only a few studies reported actual behavioural changes, most focused on psychological factors like readiness to change and feeling understood. No studies looked at long-term behavioural outcomes, and follow-up periods were often short or missing entirely.
“Many digital interventions included motivational ‘elements’ but didn’t clearly show if or how they follow formal MI practices,” said Maria Carmenza Mejia, M.D., senior author and a professor of population health, Schimdt College of Medicine. The researchers carefully mapped specific techniques used and examined how fidelity was assessed to understand what the AI tools are actually doing and how well they mirror true motivational interviewing.
Users appreciated the convenience and structure of AI systems but often missed the human touch and complex relational dynamics of face-to-face counselling, the review found. Participants varied from general adults to college students and patients with specific health conditions, with smoking cessation the most common focus, followed by substance use reduction and stress management.
Study co-authors are FAU medical students Zev Karve, Jacob Caley and Christopher Machado, and Michelle K. Knecht, senior medical librarian, FAU Schmidt College of Medicine.
