Yet despite strong evidence, MI is not widely used in clinical practice due to challenges like limited time, training demands and payment barriers. Advances in artificial intelligence, however, are opening new possibilities to bring MI to more people through digital tools.
AI-powered chatbots, apps and virtual agents can simulate the supportive, empathetic conversations at the heart of MI. Using approaches ranging from scripted dialogues to advanced large language models like GPT-4 (commonly known as ChatGPT), these tools provide around-the-clock, judgment-free support. They may be especially helpful for people who do not seek traditional behavioral health care.
Early studies suggest these AI tools are feasible and acceptable, but it remains unclear how closely they follow core MI principles such as empathy and promoting autonomy, and whether they effectively change behaviors. Evaluating this “MI fidelity” is challenging, as traditional methods need detailed human review and don’t scale well.
To fill these important knowledge gaps, researchers from Florida Atlantic University’s Charles E. Schmidt College of Medicine conducted the first scoping review of studies on AI-driven systems designed to deliver motivational interviewing.
They focused on exploring how AI tools such as chatbots and large language models are being used to deliver MI, what is known about their usability and acceptability, the extent to which these systems adhere to core MI principles, and the behavioral or psychological outcomes reported so far.
Results, published in the Journal of Medical Internet Research, reveal that the most used AI tools were chatbots, with some virtual agents and mobile apps, using technologies ranging from rule-based systems to advanced models like GPT-3.5 and GPT-4. While all aimed to simulate motivational interviewing, the quality and rigor of their evaluations varied. Only a few studies addressed safety concerns around AI-generated content, with most not detailing safeguards against misinformation or inappropriate responses.
While only a few studies reported actual behavioral changes, most focused on important psychological factors like readiness to change and feeling understood. Importantly, no studies looked at long-term behavioral outcomes, and follow-up periods were often short or missing entirely. So, while AI tools can effectively deliver motivational content and influence early signs of change, their ability to create lasting behavior shifts remains unclear.
“Many digital interventions included motivational ‘elements’ but didn’t clearly show if or how they follow formal MI practices,” said Maria Carmenza Mejia, M.D., senior author and a professor of population health, Schimdt College of Medicine. “We carefully mapped the specific techniques used – like open-ended questions, affirmations, and reflective listening – and looked at how fidelity was assessed, whether through expert review or study design. This level of detail is essential to understand what these AI tools are actually doing and how well they mirror true motivational interviewing.”
Findings show that despite their strengths, limitations around emotional nuance and conversational depth were commonly noted.
“Users appreciated the convenience and structure of AI systems but often missed the ‘human touch’ and complex relational dynamics of face-to-face counseling,” said Mejia.
Participants in the studies varied widely from general adults to college students and patients with specific health conditions. Smoking cessation was the most common focus, followed by substance use reduction, stress management, and other health behaviors.
“AI-driven systems show exciting potential to deliver motivational interviewing and support meaningful health behavior change,” said Mejia. “These tools are feasible and well-accepted across various health issues, demonstrating key principles like empathy and collaboration. However, few studies have rigorously evaluated their impact on behavior or fidelity. As AI health interventions evolve, future research must focus on robust evaluation, transparency and ethical responsibility. By blending scalable AI technology with proven behavioral frameworks, we can expand access and better support patients facing behavior change challenges.”
Study co-authors are FAU medical students Zev Karve, Jacob Caley, Christopher Machado and Michelle K. Knecht, senior medical librarian, FAU Schmidt College of Medicine.
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About the Charles E. Schmidt College of Medicine:
Florida Atlantic University’s Charles E. Schmidt College of Medicine is one of approximately 159 accredited medical schools in the U.S. The college was launched in 2010, when the Florida Board of Governors made a landmark decision authorizing FAU to award the M.D. degree. After receiving approval from the Florida legislature and the governor, it became the 134th allopathic medical school in North America. With more than 170 full and part-time faculty and more than 1,400 affiliate faculty, the college matriculates 80 medical students each year and has been nationally recognized for its innovative curriculum. The college offers M.S. (thesis and non-thesis) and Ph.D. programs in biomedical science, along with a certificate in genomics and precision medicine. Taught by top researchers, the curriculum combines innovative coursework with hands-on learning, preparing graduates for careers in medicine, research, industry, and academia. To further Florida Atlantic’s commitment to increase much needed medical residency positions in Palm Beach County and to ensure that the region will continue to have an adequate and well-trained physician workforce, the FAU Charles E. Schmidt College of Medicine Consortium for Graduate Medical Education (GME) was formed in fall 2011 with five leading hospitals in Palm Beach County. The consortium currently has five Accreditation Council for Graduate Medical Education (ACGME) accredited residencies including internal medicine, surgery, emergency medicine, psychiatry, and neurology, and five fellowships in cardiology, hospice and palliative care, geriatrics, vascular surgery, and pulmonary disease and critical care medicine. The college also manages the Florida Atlantic University Medical Group, offering comprehensive primary care, and the Marcus Institute of Integrative Health specializes in integrative pain management, precision therapies, and mental health.
About Florida Atlantic University:
Florida Atlantic University serves more than 32,000 undergraduate and graduate students across six campuses along Florida’s Southeast coast. Recognized as one of only 21 institutions nationwide with dual designations from the Carnegie Classification - “R1: Very High Research Spending and Doctorate Production” and “Opportunity College and University” - FAU stands at the intersection of academic excellence and social mobility. Ranked among the Top 100 Public Universities by U.S. News & World Report, FAU is also nationally recognized as a Top 25 Best-In-Class College and cited by Washington Monthly as “one of the country’s most effective engines of upward mobility.” As a university of first choice for students across Florida and the nation, FAU welcomed its most academically competitive incoming class in university history in Fall 2025. To learn more, visit www.fau.edu.
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