Conversational agents and equity in health care systems: a scoping review

The use of conversational agents (CAs) in healthcare has increased significantly in recent years, driven by advances in artificial intelligence, as well as evolving healthcare needs. This development has generated great enthusiasm about how CAs can improve healthcare. However, despite encouraging pilot results, their real impact on equity within healthcare systems remains unclear. This scoping review focuses on the implications of deploying CAs on equity, particularly in terms of accessibility, effectiveness, user experience, and safety. The methodology follows the framework by Arksey and O’Malley (2005). Three databases (ProQuest, Scopus, and PubMed) were used in the research. Articles published between 2014 and 2024 were included. Fourteen articles were selected, including quantitative, mixed-method, and, to a lesser extent, qualitative studies. The findings reveal a nuanced picture regarding equity. Although CAs can improve equity for certain populations in specific contexts, inequalities may also persist based on age, gender, and ethnic origin, as well as health literacy and digital literacy. In conclusion, the integration of CAs into healthcare systems does not automatically guarantee equity. Their impact depends heavily on design and adaptation to the local context. Ignoring this reality in favor of exclusively focusing on efficiency risks reinforcing inequalities.