Conversational AI technology improves sexual and reproductive health education, study finds

Young women around the world face challenges such as unintended pregnancies and sexually transmitted infections. The world’s 1.8 billion adolescents and young people (aged 15–24) of both sexes account for 42% of new HIV infections.

Sexual and reproductive health education for young women is a priority in sub-Saharan Africa, where 80% of young people living with HIV worldwide reside. Lesotho, a mountainous and impoverished country in southern Africa, has the second highest HIV prevalence in the world, with nearly 23% of the population. The country faces extremely low health workforce numbers and a terrain that makes face-to-face interactions difficult.

In a study published in BMC Global and Public HealthResearchers from Boston University Chobanian & Avedisian School of Medicine, in collaboration with Northeastern University, University of Massachusetts Chan School of Medicine, the University of Oklahoma, and Sefako Makgatho Health Sciences University in South Africa, have used conversational AI technology to successfully disseminate information about sexual and reproductive health.

“Our findings support the use of e-health solutions to address the challenges of providing high-quality, evidence-based health education to young women in low-income countries where such education is most needed,” said Elizabeth Nkabane Nkholongo, Ph.D., study leader and first author, and executive director of the Lesotho Boston Health Alliance (LeBoHA), a partnership between BU’s School of Medicine and the Lesotho Ministry of Health.

“In Lesotho, this could even lead to online health education that would far surpass face-to-face health education,” Nkholongo added.

People are familiar with the technology known as chatbots, but AI-powered embodied conversational agents (ECAs) take this a step further by engaging the user with software technology that creates an on-screen character capable of mimicking interactions with real people by conversing in the target audience’s natural language as well as with familiar gestures and other body language.

In the Lesotho study, researchers adapted an ECA model known as “Gabby” that had been used successfully to disseminate sexual and reproductive health information to African American women in the United States. The Lesotho model used hairstyles, skin tone, facial expressions, and mannerisms recognizable to young Lesotho women and constructed the character of Nthabi, a professional nurse midwife.

In this case, the choice of ECA technology was made possible by the rapid diffusion of mobile technologies such as smartphones and tablets in Lesotho. The researchers developed a Nthabi app that could be downloaded onto mobile devices without relying on the country’s unstable Wi-Fi coverage.

To analyze Nthabi’s effectiveness, the researchers recruited 172 young women with an average age of 22.5 years to use the app. They measured participants’ knowledge before and after their discussions with Nthabi about family planning, the use of folic acid (a B vitamin important for preventing birth defects of the brain and spinal cord), and healthy eating. The number of correct answers before and after the test was then compared.

“Young women participating in this study demonstrated a significant increase in their knowledge of family planning methods and their preconceptions about folic acid use after interacting with Nthabi,” the report concludes. For example, the total percentage of correct responses to questions about folic acid use increased from 45.3% when tested before using Nthabi to 71.6% when tested after using Nthabi.

According to the researchers, Nthabi could help overcome barriers inherent in traditional face-to-face education, particularly in regions like Lesotho where there are fewer health professionals and difficult geographic challenges, as well as counter the stigma surrounding discussions about sexual and reproductive health issues.

“The potential for using Nthabi as a population health education tool is a game changer as the world strives to achieve universal health coverage,” said LeBoHA President Brian Jack, MD, and professor of family medicine at BU.