**5. Recommendation**

A statement by Henry Ford reported that "*real progress happens only when the advantages of a new technology become available to everybody*". The consolidation of technologies based on chatbots is intended to bring benefits to everyone in several areas.

Among these areas we find the *health domain*, which is strategic since it has to do with the health of citizens.

The overview highlighted a particular increase in scientific interest in this area, which is accompanied, as for all other sectors of employment, by important expectations on the part of the citizen.

The overview also showed, through an analysis of the sectors most addressed by scholars in the *health domain*, that the need to deepen individual domains, such as effectiveness, legal aspects, and standardization, just to name a few, emerged from time to time.

What is necessary at this point in the evolution of these tools is to develop studies that simultaneously evaluate multiple domains all together in a synergistic way.

*To do this, it is important that scholars, experts, politicians, and stakeholders stimulate and initiate large-scale consensus initiatives that address these issues by considering the different multiple domains of intervention. Concerted actions involving experts, international scientific societies and stakeholders could be useful for tackling these strategic issues more decisively. Initiatives such as studies on health technology assessment or the Consensus Conference are strongly recommended*.

These initiatives could provide shared documents, including applications, organization models, training, regulations, ethics, and other domains [72,73].

This overview also highlights the cross-domain character of the topic of chatbots; 37 chatbot applications and some expectations have been identified [33,34].

There has always been a process of osmosis of technology between various areas and this is applicable to chatbots as well.

What is important, and this is where the stakeholders come into play, is the accurate monitoring of this process, when the process concerns the *health domain*, given that we are dealing with the health of citizens.

Another important aspect is the impact on the *health domain* that a distorted use of these tools as used in other contexts could generate.

There has recently been a discussion on addiction and the psychological impact (and therefore, on the consequences on the *health domain*) that some applications in use in the world of consumption could generate [74–76]. For example, *Replika* [74], which allows you to interact with virtual friends, has been banned in some countries, such as Italy, where the guarantor of privacy has banned its use after having identified the risk of behavioral and psychological problems, especially for young people.

Some chatbots allow you to talk to celebrities and others even to the dead, the so-called deadbots [75]. The latter are fed with memories, letters, messages from our loved ones and simulate interaction with the deceased. With these deadbots, important limits are being crossed, and we are entering a world where the implications are psychological, behavioral, and ethical. With these applications, one can enter delicate and special worlds, whose implications that can impact a person in unpredictable ways. In the religious sphere, there are chatbots created in Italy that address the sacred and the afterlife, as they simulate conversations with saints [76]. Other chatbots are venturing into very particular and specific sectors, with the implications that have been highlighted. Making a list would be unthinkable. It is precisely this difficulty that creates the need for activating serious monitoring actions in this field.
