Abstract
BACKGROUND: Chatbots, as dialog-based platforms, have the potential to transform health education and behavior-change interventions. Despite the growing use of chatbots, qualitative insights into user and provider experiences remain underexplored, particularly with respect to experiences and perceptions, adoption factors, and the role of theoretical frameworks in design. OBJECTIVE: This systematic review of qualitative evidence aims to address three key research questions (RQs): (RQ1) user and provider experiences; (RQ2) facilitators and barriers to adoption; and (RQ3) role of theoretical frameworks. METHODS: We systematically searched PubMed, the Cochrane Library, and ScienceDirect from January 1, 2018, to October 1, 2023, for English- or German-language, peer-reviewed qualitative or mixed methods studies. Studies were included if they examined users' or providers' experiences with chatbots in health education or behavior-change contexts. Two reviewers independently screened titles, abstracts, and full texts (Cohen κ=0.82). We used the Joanna Briggs Institute Critical Appraisal Checklist for quality assessment and conducted a reflexive thematic analysis following Braun and Clarke's framework. RESULTS: Among the 1754 records identified, 27 studies from 10 countries met the inclusion criteria, encompassing 241 qualitative-only participants and 10,802 mixed method participants (657 contributing qualitative data). For RQ1, users emphasized empathy and emotional connection. For RQ2, accessibility and ease of use emerged as facilitators, whereas trust deficits, technical glitches, and cultural misalignment were key barriers. For RQ3, the integration of behavior-change theories emerged as underutilized despite their potential to increase motivation. CONCLUSIONS: Chatbots demonstrate strong potential for health education and behavior-change interventions but must address privacy and trust issues, embed robust theoretical underpinnings, and overcome adoption barriers to fully realize their impact. Future directions should include evaluations of cultural adaptability and rigorous ethical considerations in chatbot design.