Exploring Young Adults’ Views About Aroha, a Chatbot for Stress Associated With the COVID-19 Pandemic: Interview Study Among Students
Authors: Kang Annie , Hetrick Sarah , Cargo Tania , Hopkins Sarah , Ludin Nicola , Bodmer Sarah , Stevenson Kiani , Holt-Quick Chester , Stasiak Karolina 
Published: May 2023

Background
In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020.

Objective
In this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha’s content in young adults and to identify areas for improvement.

Methods
We conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International).

Results
A total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87%; male students: n=2, 13%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a “real person” and peer with its friendly local “Kiwi” communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and “vent” in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars.

Conclusions
Chatbots are an acceptable format for scaling up the delivery of public mental health and well-being–enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional “mental health” support; and focus on developing features that make users feel heard, understood, and empowered.