How automated tools are being used to assess healthcare providers’ nonverbal communication skills

The quality of the relationship between a healthcare provider and their patient, known as the therapeutic alliance, has long been associated with better health outcomes, including improved symptom resolution, greater patient compliance, and higher satisfaction with care. A distinct component of this relationship is nonverbal, and measurable independently of verbal communication. 

Eye contact, facial expression, posture, proximity, and voice quality all contribute to the emotional component of the therapeutic alliance, and deficits in these nonverbal dimensions, independent of verbal communication, can worsen patient outcomes.

Measuring such behaviours accurately and consistently is difficult. Survey instruments exist, but they have been criticised for imprecision and rarely identify the specific conduct a provider needs to address. Live observation and video review offer more detail but require considerable human effort to score. A scoping review examines whether technology might offer a more practical alternative.

The scoping review mapped currently available and emerging technologies capable of collecting and analysing provider nonverbal behaviours during healthcare interactions (real or simulated) without requiring constant human oversight. 

Where artificial intelligence was employed, the review flags a concern about transparency. Training data for AI models should be openly reported to ensure tools are not applied to populations or purposes for which they are unsuited.

The review is candid about its limitations. The technology landscape is fast-moving, most included studies were at early phases of development, and questions about cultural context, the patient's perspective, and longitudinal effects remain largely unaddressed. 

What the review contributes is a structured account of where the field currently stands: which behaviours are well-served by existing tools, and which present unresolved measurement challenges. The review recommends cautious adoption of technology-assisted methods as they become available and are validated, with more work needed to assess these systems against patient experience across different cultural contexts.

The scoping review, Technology-assisted methods to assess the quality of the therapeutic alliance between health care providers and patients, is available in the May 2026 issue of JBI Evidence Synthesis.