Generative Artificial Intelligence Chatbots for Motivational Interviewing: A Scoping Review From System Design to Intervention Outcomes

Abstract

Motivational interviewing (MI) is a collaborative approach to elicit autonomous motivation for health behavior change. Generative AI (GenAI) offers new ways to deliver MI via conversational systems, but evidence on their design, assessment, and translation into interventions remains fragmented. This scoping review characterized evidence on GenAI-MI chatbots across system design, safety, MI quality, user perceptions, and intervention outcomes. We conducted a PRISMA-ScR scoping review. Nine datasets were searched for studies published or publicly available from January 1, 2015 to June 2, 2026 that used GenAI to generate MI chatbot responses or counselor utterances. Data were extracted using a predefined framework and synthesized descriptively. Forty-seven reports (48 studies) were included. Twenty (41.7%) focused on system design without direct participant use; 28 (58.3%) involved direct interaction. Most systems were text based and disembodied; 23 (47.9%) incorporated dynamic adaptation. Safety measures were unevenly reported. Among studies with direct use, 21/28 (75.0%) reported informed consent or user education. Thirty (62.5%) assessed MI quality, generally suggesting MI-consistent interactions. User perceptions were favorable, especially empathy, usability, helpfulness, and intention to use, though measures were heterogeneous. Eighteen (37.5%) reported intervention outcomes, mostly after a single session. Positive findings were more consistent for short-term motivation than sustained behavioral or functional change. GenAI-MI chatbots can deliver MI-consistent interactions perceived favorably, but evidence for sustained behavioral or functional change is limited. Future research should strengthen runtime safety monitoring, standardize MI quality assessment, and use longer-term comparative designs with behavioral and functional outcomes.