• Gilly Dosovitsky, Blanca S Pineda, Nicholas C Jacobson, Cyrus Chang, Milagros Escoredo, and Eduardo L Bunge.
• Palo Alto University, Palo Alto, CA, United States.
• JMIR Form Res. 2020 Nov 13; 4 (11): e17065.

BackgroundChatbots could be a scalable solution that provides an interactive means of engaging users in behavioral health interventions driven by artificial intelligence. Although some chatbots have shown promising early efficacy results, there is limited information about how people use these chatbots. Understanding the usage patterns of chatbots for depression represents a crucial step toward improving chatbot design and providing information about the strengths and limitations of the chatbots.ObjectiveThis study aims to understand how users engage and are redirected through a chatbot for depression (Tess) to provide design recommendations.MethodsInteractions of 354 users with the Tess depression modules were analyzed to understand chatbot usage across and within modules. Descriptive statistics were used to analyze participant flow through each depression module, including characters per message, completion rate, and time spent per module. Slide plots were also used to analyze the flow across and within modules.ResultsUsers sent a total of 6220 messages, with a total of 86,298 characters, and, on average, they engaged with Tess depression modules for 46 days. There was large heterogeneity in user engagement across different modules, which appeared to be affected by the length, complexity, content, and style of questions within the modules and the routing between modules.ConclusionsOverall, participants engaged with Tess; however, there was a heterogeneous usage pattern because of varying module designs. Major implications for future chatbot design and evaluation are discussed in the paper.©Gilly Dosovitsky, Blanca S Pineda, Nicholas C Jacobson, Cyrus Chang, Eduardo L Bunge. Originally published in JMIR Formative Research (http://formative.jmir.org), 13.11.2020.

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