Framework for Guiding the Development of High-Quality Conversational Agents in Healthcare

Denecke, Kerstin (2023). Framework for Guiding the Development of High-Quality Conversational Agents in Healthcare Healthcare, 11(8), 1061/1-22. MDPI 10.3390/healthcare11081061

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Evaluating conversational agents (CAs) that are supposed to be applied in healthcare settings and ensuring their quality is essential to avoid patient harm and ensure efficacy of the CA-delivered intervention. However, a guideline for a standardized quality assessment of health CAs is still missing. The objective of this work is to describe a framework that provides guidance for development and evaluation of health CAs. In previous work, consensus on categories for evaluating health CAs has been found. In this work, we identify concrete metrics, heuristics, and checklists for these evaluation categories to form a framework. We focus on a specific type of health CA, namely rule-based systems that are based on written input and output, have a simple personality without any kind of embodiment. First, we identified relevant metrics, heuristics, and checklists to be linked to the evaluation categories through a literature search. Second, five experts judged the metrics regarding their relevance to be considered within evaluation and development of health CAs. The final framework considers nine aspects from a general perspective, five aspects from a response understanding perspective, one aspect from a response generation perspective, and three aspects from an aesthetics perspective. Existing tools and heuristics specifically designed for evaluating CAs were linked to these evaluation aspects (e.g., Bot usability scale, design heuristics for CAs); tools related to mHealth evaluation were adapted when necessary (e.g., aspects from the ISO technical specification for mHealth Apps). The resulting framework comprises aspects to be considered not only as part of a system evaluation, but already during the development. In particular, aspects related to accessibility or security have to be addressed in the design phase (e.g., which input and output options are provided to ensure accessibility?) and have to be verified after the implementation phase. As a next step, transfer of the framework to other types of health CAs has to be studied. The framework has to be validated by applying it during health CA design and development.

Item Type:

Journal Article (Original Article)


School of Engineering and Computer Science > Institute for Patient-centered Digital Health
School of Engineering and Computer Science


Denecke, Kerstin0000-0001-6691-396X


Q Science > Q Science (General)








Kerstin Denecke

Date Deposited:

24 May 2023 10:40

Last Modified:

25 Oct 2023 13:41

Publisher DOI:


Related URLs:

Uncontrolled Keywords:

Conversational agent Chatbot Evaluation Quality Patient safety




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