Awareness of Artificial Intelligence (AI) based Chatbot Services among the Nursing Ward Managers of a Tertiary Care Hospital in South India

Introduction

The healthcare industry is fast growing in terms of technology and services. Artificial Intelligence (AI) based chatbot services could make a difference through chat or natural language conversation with the patient over messaging apps, web-based services, or through telephonic conversation. Healthcare administrators and nurse managers are required to know about the influence of such technology on better patient care. Thus, it is imperative to assess the awareness of nursing managers on chatbot services, to enable them to train their subordinates who can efficiently impart awareness among the patients. Further, the nurse managers may recommend to the relevant hospital administrative sections the features and upgrades that are required in the chatbot services based on patients’ perspectives.

A chatbot is one of the latest intelligent systems that interact with patients and provide an answer to their queries under a variety of domains.¹ Courtesy ensures efficient communication. Therefore, customizing chatbot, to include politeness for efficient interaction will surely lead to a pleasant patient experience. The functionality of chatbot as a software-based application interacts with the user through text messages or audio. ² Various possibilities of a chatbot technology include healthrelated patient surveys, healthcare-related reminders to users, interaction with physicians, appointment booking, and receiving health data.³ This facilitates the user to send and receive information. The data required is stored in the database by the owner, as per the need of the user.

AI-based chatbot can provide the patient with basic diagnostic information before consultation with the physician.⁴ Patients can also communicate through text messages regarding their medical ailments and the chatbot can provide them with a diagnosis based on their symptoms and enables patients to have better knowledge about their health status. This functionality of the chatbot is a welcome change in the modern era.

Screening patients is essential to reduce the avoidable workload at various health services. Chatbots are cost-effective in their implementation to screen larger patient groups before the hospital visit. Chatbot imparts education and information to patients and triages patients by directing them to telephone triage or telehealth services.⁵ As healthcare organizations understand these technologies, chatbot services can be employed for emergencies as well as routine care. Clinical chatbots have been shown to reduce service costs and increase access to information. Few chatbots are utilized as clinical reference databases.⁶

People communicate with intelligent technology and there appears to be a great shift in ways of communication with the introduction of technology.⁷ Human communication abilities move easily with chatbot communications, however, the content and quality of communication vary among different chatbot services.

Many patients are open to healthcare chatbots, but at the same time are anxious to use such modules. ⁸ To take care of the users’ concerns and provide efficient and ethical services, there must be a user-centered focus in designing these services. There is an increased use of text messaging chatbot systems which has gained popularity in recent times. ⁹ Avoidable visits to clinics and hospitals can be eliminated by utilizing a healthcare chatbot. Further, healthcare chatbots are also of tremendous use in preventive medicine. A well-designed chatbot can assist patients in rural areas that lack healthcare facilities and help to reach out to physicians, as these areas are not physician-friendly due to a lack of resources.¹⁰

Keeping in mind, the paradigm shift of the healthcare industry towards modernization, AI-powered chatbot systems will certainly enable better patient healthcare services and end-user satisfaction. Chabot interactions may also reduce hospital visits. While the nursing staff plays an important role in patient care, they also play a key role in training and creating awareness about various aspects of the healthcare system including chatbot services among the patients/public. The present study aimed to assess the awareness of AI-based chatbot services among the nursing ward managers working in a tertiary care teaching hospital.

Materials and Methods

This was a descriptive, prospective study carried out for a duration of one year (2020– 2021). The data was collected from the nursing ward managers in the general and private wards in a tertiary care teaching hospital located in South Karnataka catering to a mixed population. A total of 33 nursing ward managers were recruited for the study. A structured questionnaire consisting of 26 close-ended questions with binary answers was prepared covering four domains of AI-based chatbot services (basic functions of a chatbot, chatbot usage by patients to seek information, awareness on the general benefits of chatbot and awareness of nursing ward managers on barriers to implementation of chatbot). The right answer carried one score and the wrong answer carried a zero score.

The research tool was given to experts for content validity and revised as per their suggestions. Informed consent was obtained from the participants before the administration of the questionnaire. Nursing ward managers with more than one year of work experience were included in the study. Nursing ward managers of the Intensive Care Unit (ICU), postoperative wards, and psychiatry wards were excluded from the study.

Results

The data was compiled from all the questionnaires. The analyzed data obtained under various domains were shown in the tables.

1. Demographic data of the respondents

Table 1 showed that 52% of the participants were in the age group of 31–40 years. 73% of the respondents had an educational qualification of general Nursing and Midwifery diploma and 58% had a work experience of more than 5 years.

2. Assessment of awareness of Artificial Intelligence (AI) based chatbot services among the nursing ward managers

The data obtained in the questionnaire was assessed and categorized based on the total percentage of the study population being aware of the domain under study. Assessment scale: Poor awareness:0–50%; Moderate awareness:51–75%; Good awareness:≥75%.

A large number of participants were aware that a chatbot interacts with patients to provide information and half of the participants were aware of chatbot activities as a communication agent.

Thus, the level of awareness among the study participants on the basic functions of the chatbot was found to be moderate (65.15%). 

The level of awareness among the study participants on chatbot usage by patients to seek information was found to be moderate (67.05%).

The level of awareness among the study participants on the general benefits of chatbots to patients was found to be moderate (62.88%).

The level of awareness among the study participants on the barriers to the implementation of the chatbot was found to be moderate (52.3%).

The overall awareness of AI-based chatbot services among the study participants was found to be moderate (61.84%).

Discussion

Artificial Intelligence with enormous applications is booming in the healthcare industry and the use of electronic gadgets for communication has become common. The awareness about chatbots among healthcare managers and the subsequent delivery of healthcare through these channels continues to remain a concern. In this regard, the present study was conducted to assess the awareness of various functions of AI-based chatbot services among nursing ward managers. 

The result of our study showed moderate awareness among the participants about the various functions of health chatbots. A significant number of respondents were aware of the basic functions of a chatbot as a communication agent between the healthcare provider and patient, playing as an educationalist, a counselor, and a physician. However, the participants showed poor awareness of the chatbot’s role in displaying medical results and getting advice from appropriate specialists. The results further confirm the awareness of a large number of participants about chatbots imparting education to patients. Similarly, the findings of Yin et al.,¹¹ reported that chatbots play different roles in education and focused on the methods of analyzing and predicting user learning behaviors.

The participants in our study agreed that chatbots could be utilized by patients to gain past health information and give alerts about critical medical issues. Schachner et al.,¹² in their study featured some interesting and relevant findings regarding the use of professional chatbot interaction to provide precise, evidence-based, and timely health information. The study conducted by Ivanovic and Semnic¹³ emphasized the role of AI-based chatbot technologies to improve diagnostic accuracy and enable physicians to provide patient-centered medical care while also removing regional variances and assisting patients in self-managing their diseases.

Thus, AI-based systems offer great prospects in improving patient treatment and transforming today’s health care.¹⁴ However, before the application of innovative AI tools in routine clinical care, investigations of their safety, benefit as well as operational feasibility needs to be cautiously investigated.¹⁵ 

Conclusion

The delivery of universally accessible healthcare could undergo a revolutionary transition, with the help of chatbots. There is already an extensive usage of mobilebased technology in many fields. The latest features of a user-friendly chatbot application that is compatible with these devices need to be developed and customized by healthcare providers. Nursing professionals play a crucial role in creating user awareness. Thus, nurse managers and nursing staff have to be knowledgeable about the features and advantages of chatbot technology. Healthcare organizations need to equip themselves for the technological changes and aim at bringing out comprehensive chatbot software to enhance the patient experience and deliver better service.

Limitations of the study

• The study was limited to the setting of a non-profit hospital.

• A study on a larger population will help to strategize further plans for the establishment of AI-based chatbot services in providing better healthcare to patients.

• The user acceptance of the chatbot technology needs to be studied.

Conflict of interest

Nil