Developing Embodied Conversational Agents for Coaching People in a Healthy Lifestyle: Scoping Review

Lean L Kramer, Silke ter Stal, Bob C. Mulder, Emely de Vet, Lex van Velsen

Research output: Contribution to journalArticleAcademicpeer-review

32 Citations (Scopus)
64 Downloads (Pure)


Background: Embodied conversational agents (ECAs) are animated computer characters that simulate face-to-face counseling. Owing to their capacity to establish and maintain an empathic relationship, they are deemed to be a promising tool for starting and maintaining a healthy lifestyle.

Objective: This review aimed to identify the current practices in designing and evaluating ECAs for coaching people in a healthy lifestyle and provide an overview of their efficacy (on behavioral, knowledge, and motivational parameters) and use (on usability, usage, and user satisfaction parameters).

Methods: We used the Arksey and O’Malley framework to conduct a scoping review. PsycINFO, Medical Literature Analysis and Retrieval System Online, and Scopus were searched with a combination of terms related to ECA and lifestyle. Initially, 1789 unique studies were identified; 20 studies were included.

Results: Most often, ECAs targeted physical activity (n=16) and had the appearance of a middle-aged African American woman (n=13). Multiple behavior change techniques (median=3) and theories or principles (median=3) were applied, but their interpretation and application were usually not reported. ECAs seemed to be designed for the end user rather than with the end user. Stakeholders were usually not involved. A total of 7 out of 15 studies reported better efficacy outcomes for the intervention group, and 5 out of 8 studies reported better use-related outcomes, as compared with the control group.

Conclusions: ECAs are a promising tool for persuasive communication in the health domain. This review provided valuable insights into the current developmental processes, and it recommends the use of human-centered, stakeholder-inclusive design approaches, along with reporting on the design activities in a systematic and comprehensive manner. The gaps in knowledge were identified on the working mechanisms of intervention components and the right timing and frequency of coaching.
Original languageEnglish
Number of pages11
JournalJournal of medical internet research
Issue number2
Publication statusPublished - 6 Feb 2020


  • Embodied conversational agent
  • Virtual agent
  • Lifestyle
  • Health behavior
  • eHealth
  • Chatbots


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