Psychological, economic, and ethical factors in human feedback for a chatbot-based smoking cessation intervention

Abstract Integrating human support with chatbot-based behavior change interventions raises three challenges: (1) attuning the support to an individual’s state (e.g., motivation) for enhanced engagement, (2) limiting the use of the concerning human resources for enhanced efficiency, and (3) optimizin...

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Main Authors: Nele Albers, Francisco S. Melo, Mark A. Neerincx, Olya Kudina, Willem-Paul Brinkman
Format: Article
Language:English
Published: Nature Portfolio 2025-05-01
Series:npj Digital Medicine
Online Access:https://doi.org/10.1038/s41746-025-01701-3
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author Nele Albers
Francisco S. Melo
Mark A. Neerincx
Olya Kudina
Willem-Paul Brinkman
author_facet Nele Albers
Francisco S. Melo
Mark A. Neerincx
Olya Kudina
Willem-Paul Brinkman
author_sort Nele Albers
collection DOAJ
description Abstract Integrating human support with chatbot-based behavior change interventions raises three challenges: (1) attuning the support to an individual’s state (e.g., motivation) for enhanced engagement, (2) limiting the use of the concerning human resources for enhanced efficiency, and (3) optimizing outcomes on ethical aspects (e.g., fairness). Therefore, we conducted a study in which 679 smokers and vapers had a 20% chance of receiving human feedback between five chatbot sessions. We find that having received feedback increases retention and effort spent on preparatory activities. However, analyzing a reinforcement learning (RL) model fit on the data shows there are also states where not providing feedback is better. Even this “standard” benefit-maximizing RL model is value-laden. It not only prioritizes people who would benefit most, but also those who are already doing well and want feedback. We show how four other ethical principles can be incorporated to favor other smoker subgroups, yet, interdependencies exist.
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spelling doaj-art-3fc96cc59fdc4e3e8780d70793abcdf62025-08-20T02:03:39ZengNature Portfolionpj Digital Medicine2398-63522025-05-018111410.1038/s41746-025-01701-3Psychological, economic, and ethical factors in human feedback for a chatbot-based smoking cessation interventionNele Albers0Francisco S. Melo1Mark A. Neerincx2Olya Kudina3Willem-Paul Brinkman4Department of Intelligent Systems, Delft University of TechnologyINESC-ID and Instituto Superior Técnico, Universidade de LisboaDepartment of Intelligent Systems, Delft University of TechnologyDepartment of Values, Technology and Innovation, Delft University of TechnologyDepartment of Intelligent Systems, Delft University of TechnologyAbstract Integrating human support with chatbot-based behavior change interventions raises three challenges: (1) attuning the support to an individual’s state (e.g., motivation) for enhanced engagement, (2) limiting the use of the concerning human resources for enhanced efficiency, and (3) optimizing outcomes on ethical aspects (e.g., fairness). Therefore, we conducted a study in which 679 smokers and vapers had a 20% chance of receiving human feedback between five chatbot sessions. We find that having received feedback increases retention and effort spent on preparatory activities. However, analyzing a reinforcement learning (RL) model fit on the data shows there are also states where not providing feedback is better. Even this “standard” benefit-maximizing RL model is value-laden. It not only prioritizes people who would benefit most, but also those who are already doing well and want feedback. We show how four other ethical principles can be incorporated to favor other smoker subgroups, yet, interdependencies exist.https://doi.org/10.1038/s41746-025-01701-3
spellingShingle Nele Albers
Francisco S. Melo
Mark A. Neerincx
Olya Kudina
Willem-Paul Brinkman
Psychological, economic, and ethical factors in human feedback for a chatbot-based smoking cessation intervention
npj Digital Medicine
title Psychological, economic, and ethical factors in human feedback for a chatbot-based smoking cessation intervention
title_full Psychological, economic, and ethical factors in human feedback for a chatbot-based smoking cessation intervention
title_fullStr Psychological, economic, and ethical factors in human feedback for a chatbot-based smoking cessation intervention
title_full_unstemmed Psychological, economic, and ethical factors in human feedback for a chatbot-based smoking cessation intervention
title_short Psychological, economic, and ethical factors in human feedback for a chatbot-based smoking cessation intervention
title_sort psychological economic and ethical factors in human feedback for a chatbot based smoking cessation intervention
url https://doi.org/10.1038/s41746-025-01701-3
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