# Effects of Long-Term Chatbot System Use on Healthcare Professionals' Professional Identity Formation and Stress: A Small-Scale Comparative Study

## TL;DR

A chatbot system used over nine months helped healthcare professionals in Japan develop their professional identity and reduce stress, according to a small study.

## Contribution

This study is the first to examine long-term effects of a chatbot system on professional identity and stress in healthcare professionals.

## Key findings

- Chatbot users showed significant improvements in professional identity development compared to non-users.
- Stress levels, particularly anxiety and depressive mood, were significantly reduced in chatbot users.
- Results were observed over a nine-month period with periodic assessments.

## Abstract

Background

Digital mental health interventions, including chatbot systems, are increasingly recognized for their potential to address mental health challenges among healthcare professionals. In particular, reflective practices facilitated by chatbots may support identity development and alleviate stress. However, the long-term effects of such interventions remain underexplored.

Objective

This study investigated the effects of a chatbot system using the line chart method over approximately nine months on the professional identity development and stress levels of healthcare professionals in Japan.

Methods

Professional identity formation specifically refers to how healthcare professionals perceive, develop, and integrate their professional roles and responsibilities into their self-concept. To evaluate this construct and associated stress levels, a parallel-group design was employed, in which eight participants (nurses and physical therapists) were randomly allocated to either a system-use group (Group A) or a non-use group (Group B). Both groups were followed for nine months, with periodic assessments conducted before and after the intervention, as well as after a washout period. The Japanese version of the Dimensions of Identity Development Scale (DIDS-J), assessing Commitment Formation, Identification with Commitment, Broad Exploration, Deep Exploration, and Ruminative Exploration, and the Public Health Research Foundation Stress Checklist Short Form (PHRF-SCL), evaluating Anxiety/Uncertainty, Fatigue/Physical Responses, Autonomic Symptoms, and Depressive Mood/Inadequacy, were administered.

Results

In the between-group comparisons, Group A demonstrated statistically significant improvements compared to Group B in the DIDS-J subscales, including Commitment Formation (16.5±0.6 vs. 14.0±0.8), Identification with Commitment (16.5±0.6 vs. 14.3±1.0), Broad Exploration (18.0±0.8 vs. 15.0±0.8), and Deep Exploration (18.0±1.1 vs. 14.5±1.3). Additionally, significant improvements were observed in the PHRF-SCL subscales, specifically Anxiety/Uncertainty (5.5±1.3 vs. 7.5±0.6), Fatigue/Physical Responses (4.5±0.6 vs. 7.8±1.3), and Depressive Mood/Inadequacy (4.5±1.3 vs. 9.3±0.6).

Conclusion

The results suggest that long-term use of a chatbot system employing reflective methods may promote professional identity development and reduce certain stress responses in healthcare professionals. Nonetheless, sample size limitations, pre-existing group differences, and environmental variables constrain the interpretation of findings. Future research with larger and more diverse populations, extended follow-up periods, and additional physiological or life-event measures is warranted to validate and refine these preliminary outcomes.