Machine learning-based artificial intelligence (AI) chatbots are increasingly used to promote health and encourage individuals to adopt healthier behaviors. Chatbots driven by generative AI (genAI) simulate human interactions through text or voice to generate personalized content with guidance on topics such as smoking cessation, nutrition, managing stress, and sleep improvement. The use of AI chatbots for health promotion and wellness has been growing since 2023. While empirical evidence suggests their effectiveness in supporting behavioral change and mental health, the legal, ethical, and societal implications remains largely unexplored. This article presents a qualitative case study of S.A.R.A.H. (Smart AI Resource Assistant for Health), a genAI chatbot developed by the World Health Organization (WHO), analyzed against the six ethical principles outlined in the WHO's 2021 Guidance on Ethics and Governance of AI for Health. We also gathered exploratory insights from adolescent focus groups. These findings are descriptive and not based on formal thematic analysis. Drawing on this analysis, we identify key gaps between high-level ethical principles and practice and offer policy recommendations to guide responsible use of AI chatbots for health promotion.

Machine learning algorithms show promise in assisting clinical decision-making; however, only a few have been successfully implemented in practice. To bridge this gap, it is essential to analyse the clinicians’ perspective on the compatibility of Artificial Intelligence-based clinical decision support systems (AI-CDSSs) with their clinical tasks. We therefore conducted a literature review of 21 empirical qualitative studies that examined the interaction between health professionals and AI-CDSSs. We synthesised the research through the lens of the Task-Technology Fit (TTF) model, analysing task, technology and individual characteristics of AI-CDSS applications, to identify design elements that are (mis)aligned with clinicians’ needs. Three key findings emerged from our analysis. First, clinicians often expressed scepticism about the clinical judgements of AI-CDSSs, particularly questioning the system’s ability to compete with clinical expertise in the absence of contextual information. Users valued AI primarily for specific strengths, such as identifying trends in patient trajectories, consolidating large datasets and pattern recognition, and comparing similar patient cases, but were hesitant to rely on it for clinical decisions. Second, actionability emerged as a desired characteristic of AI-CDSSs. For instance, clinicians particularly appreciated features of AI-CDSSs that enabled them to explore how different clinical actions might influence outcomes, as well as Explainable AI for identifying modifiable variables that impacted prediction scores, allowing them to take informed action. Third, we identified various ways AI-CDSSs could be used in clinical practice, including for patient prioritisation, patient monitoring, care acceleration, risk communication and workflow efficiency. In essence, AI-CDSSs functioned either as an alert system, preventing oversights, or as a tool for more informed decision making. Our analysis challenges the assumption that AI-CDSSs add little value when clinicians disregard its predictions, as it frequently prompts them to critically reassess their judgments through additional testing, consultation with colleagues, and other actions. Overall, our findings underscore the importance of an in-depth understanding of how AI-CDSSs are used in clinical practice. To optimise for effectiveness, the design of AI-CDSSs should prioritise supporting clinicians’ cognitive processes and information needs. This approach ensures that we move beyond the hype, focusing on the responsible integration of AI-CDSSs, and ultimately enhancing patient care.