Vol. 3 No. 2 (2026): August 2026
Articles

Digital Empathy as an Evolving Socio-Technological Construct: A Temporal Evolution Concept Analysis

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  • Cyruz P. Tuppal
Cyruz P. Tuppal
Institute of Nursing, University of Makati, Philippines; Department of Nursing, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
DOI: https://doi.org/10.70848/cnj.v3i2.123

Published 2026-08-07

Keywords

  • Artificial Intelligence,
  • Empathy,
  • Health Communication,
  • Telemedicine,
  • User-Computer Interface

How to Cite

Tuppal, C. P. (2026). Digital Empathy as an Evolving Socio-Technological Construct: A Temporal Evolution Concept Analysis. Celebes Nursing Journal, 3(2), 382–396. https://doi.org/10.70848/cnj.v3i2.123

Abstract

Introduction: Empathy has traditionally been understood as an embodied and relational process within face-to-face healthcare interactions; however, the rapid integration of digital technologies has transformed the conditions under which empathic engagement occurs. Objective: This study aimed to examine the temporal evolution of digital empathy and to develop a theoretically grounded conceptualization reflecting its transformation across technological eras. Methods: A historical–comparative concept analysis using Temporal Evolution Concept Analysis (TECA) was undertaken to interpret how digital empathy has evolved across technologically mediated healthcare contexts. Drawing on peer-reviewed literature retrieved from the Scopus, ScienceDirect, and CINAHL databases, the analysis involved iterative corpus assembly, temporal segmentation, cross-era comparison, evolution tracing, and conceptual trajectory synthesis. Results: The analysis suggests four interconnected phases of digital empathy: human-centered, mediated, hybrid, and artificial intelligence-mediated empathy. Across these phases, shifts were observed from physical presence to mediated presence, from emotional attunement to digital responsiveness, and from embodiment to virtual embodiment. These transformations appear to reflect broader technological developments, evolving healthcare delivery models, and global disruptions. Conclusion: Rather than a static extension of traditional empathy, digital empathy is proposed as an adaptive, evolving socio-technological construct shaped by changing modes of relational engagement. A conceptual trajectory model is proposed, offering implications for clinical practice, health professional education, digital health policy, and the ethical integration of emerging technologies.

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References

  1. Agha, Z., Schapira, R. M., & Laud, P. W. (2009). Patient satisfaction with physician–patient communication during telemedicine. Telemedicine and e-Health, 15(9), 830–839. https://doi.org/10.1089/tmj.2009.0030
  2. Alligood, M. R., & May, B. A. (2000). A nursing theory of personal system empathy: Interpreting a conceptualization of empathy in King’s interacting systems. Nursing Science Quarterly, 13(3), 243–247. https://doi.org/10.1177/08943180022107645
  3. Ayers, J. W., Poliak, A., Dredze, M., Leas, E. C., Zhu, Z., Kelley, J. B., Faix, D. J., Goodman, A. M., Longhurst, C. A., Hogarth, M., & Smith, D. M. (2023). Comparing physician and artificial intelligence chatbot responses to patient questions posted to a public social media forum. JAMA Internal Medicine, 183(6), 589–596. https://doi.org/10.1001/jamainternmed.2023.1838
  4. Bickmore, T., & Picard, R. (2005). Establishing and maintaining long-term human-computer relationships. ACM Transactions on Computer-Human Interaction, 12(2), 293–327. https://doi.org/10.1145/1067860.1067867
  5. Booth, R. G., Strudwick, G., McBride, S., O’Connor, S., & Solano López, A. L. (2021). How the nursing profession should adapt for a digital future. BMJ, 373, n1190. https://doi.org/10.1136/bmj.n1190
  6. Budd, G., Griffiths, D., Howick, J., Vennik, J., Bishop, F. L., Durieux, N., & Everitt, H. A. (2022). Empathy in patient–clinician interactions when using telecommunication: A rapid review of the evidence. PEC Innovation, 1, 100065. https://doi.org/10.1016/j.pecinn.2022.100065
  7. Budd, J., Miller, B. S., Manning, E. M., Lampos, V., Zhuang, M., Edelstein, M., Rees, G., Emery, V. C., Stevens, M. M., Keegan, N., Short, M. J., Pillay, D., Manley, E., Cox, I. J., Heymann, D., Johnson, A. M., & McKendry, R. A. (2020). Digital technologies in the public-health response to COVID-19. Nature Medicine, 26, 1183–1192. https://doi.org/10.1038/s41591-020-1011-4
  8. Collins, K., Nicolson, P., & Bowns, I. (2000). Patient satisfaction in telemedicine. Health Informatics Journal, 6(2), 81–85. https://doi.org/10.1177/146045820000600205
  9. Gerber, B. S., & Eiser, A. R. (2001). The patient-physician relationship in the Internet age: Future prospects and the research agenda. Journal of Medical Internet Research, 3(2), e15. https://doi.org/10.2196/jmir.3.2.e15
  10. Halldórsdóttir, S., & Hamrin, E. (1997). Caring and uncaring encounters within nursing and health care from the cancer patient's perspective. Cancer Nursing, 20(2), 120–128. https://doi.org/10.1097/00002820-199704000-00007
  11. Hubley, S., Lynch, S. B., Schneck, C., Thomas, M., & Shore, J. (2016). Review of key telepsychiatry outcomes. World Journal of Psychiatry, 6(2), 269–282. https://doi.org/10.5498/wjp.v6.i2.269
  12. Inkster, B., Sarda, S., & Subramanian, V. (2018). An empathy-driven, conversational artificial intelligence agent for digital mental health. JMIR mHealth and uHealth, 6(11), e12106. https://doi.org/10.2196/12106
  13. Kemp, M. T., Liesman, D. R., & Williams, A. M. (2020). The impact of COVID-19 on telemedicine implementation in surgical specialties. The American Journal of Surgery, 220(4), 917–924. https://doi.org/10.1016/j.amjsurg.2020.06.038
  14. Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 7(8), e016242. https://doi.org/10.1136/bmjopen-2017-016242
  15. Lupton, D. (2015). Digital sociology. Routledge. https://doi.org/10.4324/9781315776880
  16. Mair, F., & Whitten, P. (2000). Systematic review of studies of patient satisfaction with telemedicine. BMJ, 320(7248), 1517–1520. https://doi.org/10.1136/bmj.320.7248.1517
  17. Miller, E. A. (2001). Telemedicine and doctor–patient communication: An analytical survey of the literature. Journal of Telemedicine and Telecare, 7(1), 1–17. https://doi.org/10.1258/1357633011936075
  18. Morris, R. R., Kouddous, K., Kshirsagar, R., & Schueller, S. M. (2018). Towards an artificially empathic conversational agent for mental health applications: System design and user perceptions. Journal of Medical Internet Research, 20(6), e10148. https://doi.org/10.2196/10148
  19. Morse, J. M., Anderson, G., Bottorff, J. L., Yonge, O., O’Brien, B., Solberg, S. M., & McIlveen, K. H. (1992). Exploring empathy: A conceptual fit for nursing practice? Image: The Journal of Nursing Scholarship, 24(4), 273–280. https://doi.org/10.1111/j.1547-5069.1992.tb00733.x
  20. Morse, J. M., Bottorff, J. L., Anderson, G., O’Brien, B., & Solberg, S. M. (1992). Beyond empathy: Expanding expressions of caring. Journal of Advanced Nursing, 17(8), 809–821. https://doi.org/10.1111/j.1365-2648.1992.tb02002.x
  21. Morse, J. M., Bottorff, J. L., Neander, W. L., & Solberg, S. M. (1991). Comparative analysis of conceptualizations and theories of caring. Image: The Journal of Nursing Scholarship, 23(2), 119–126. https://doi.org/10.1111/j.1547-5069.1991.tb00655.x
  22. Nambisan, P. (2011). Information seeking and social support in online health communities: Impact on patients’ perceived empathy. Journal of the American Medical Informatics Association, 18(3), 298–304. https://doi.org/10.1136/amiajnl-2010-000058
  23. Reynolds, W. J., Scott, P. A., & Austin, W. (2000). Nursing, empathy and perception of the moral. Journal of Advanced Nursing, 32(1), 235–242. https://doi.org/10.1046/j.1365-2648.2000.01440.x
  24. Sakumoto, M., & Joshi, A. (2023). Digital empathy 2.0: Connecting with patients using the written word. Telehealth and Medicine Today, 8(5). https://doi.org/10.30953/thmt.v8.433
  25. Sakumoto, M., & Krug, S. (2021). Enhancing digital empathy and reimagining the telehealth experience. Telehealth and Medicine Today, 6(4). https://doi.org/10.30953/tmt.v6.304
  26. Shachar, C., Engel, J., & Elwyn, G. (2020). Implications for telehealth in a postpandemic future. JAMA, 323(23), 2375–2376. https://doi.org/10.1001/jama.2020.7943
  27. Shore, J. H., Yellowlees, P., Caudill, R., Johnston, B., Turvey, C., Mishkind, M., Krupinski, E., & Myers, K. (2018). Best practices in videoconferencing-based telemental health. Telemedicine and e-Health, 24(11), 827–832. https://doi.org/10.1089/tmj.2018.0237
  28. Suchman, A. L., Markakis, K., Beckman, H. B., & Frankel, R. (1997). A model of empathic communication in the medical interview. JAMA, 277(8), 678–682. https://doi.org/10.1001/jama.1997.03540320082047
  29. Tan, S. S. L., & Goonawardene, N. (2017). Internet health information seeking and the patient–physician relationship: A systematic review. Journal of Medical Internet Research, 19(1), e9. https://doi.org/10.2196/jmir.6877
  30. Topol, E. (2019). High-performance medicine: The convergence of human and artificial intelligence. Nature Medicine, 25, 44–56. https://doi.org/10.1038/s41591-018-0300-7
  31. Tudor Car, L., Dhinagaran, D. A., Kyaw, B. M., Kowatsch, T., Joty, S., Theng, Y.-L., & Atun, R. (2020). Conversational agents in health care: Scoping review and conceptual analysis. Journal of Medical Internet Research, 22(8), e17158. https://doi.org/10.2196/17158
  32. Tuppal, C. P., Tuppal, S. M. P., Tuppal, S. M., & Ninobla, M. M. G. (2025). Towards a relational understanding of human beings in an AI-mediated world: A hermeneutical reading. Scandinavian Journal of Caring Sciences, 39(3), e70097. https://doi.org/10.1111/scs.70097
  33. Tuppal, C. P., Vega, P. D., & Tuppal, S. M. P. (2021). Towards a theory of communion‐in‐caring. Scandinavian Journal of Caring Sciences, 36(2), 524–535. https://doi.org/10.1111/scs.13049
  34. van Lotringen, C., Lusi, B., Westerhof, G. J., Ludden, G. D. S., Kip, H., Kelders, S. M., & Noordzij, M. L. (2023). The role of compassionate technology in blended and digital mental health interventions: Systematic scoping review. JMIR Mental Health, 10, e42403. https://doi.org/10.2196/42403
  35. Watson, J. (2018). Unitary caring science: The philosophy and praxis of nursing. University Press of Colorado.
  36. Whitten, P., Holtz, B., & Nguyen, L. (2010). Keys to a successful and sustainable telemedicine program. International Journal of Technology Assessment in Health Care, 26(2), 211–216. https://doi.org/10.1017/S026646231000005X
  37. Whitten, P., & Love, B. (2005). Patient and provider satisfaction with the use of telemedicine: Overview and rationale for cautious enthusiasm. Journal of Postgraduate Medicine, 51(4), 294–300.