Do Demographic Factors Influence Uveitis Patients’ Understanding of Uveitis?

Social Determinants of Health in Uveitis: A Literature Review

BACKGROUND

The uveitides are a group of intraocular inflammatory diseases which can lead to blindness without treatment. It has been shown that socioeconomic status, health literacy, and access to healthcare play a pivotal role in the prevalence, severity, and treatment outcomes in ophthalmic conditions. We review the current literature on the impact of social determinants of health (SDoH) in patients with uveitis.

METHODS

A systematic literature search was conducted utilizing PubMed, Google Scholar, and Embase databases in July 2024. Inclusion criteria included studies written in English, focusing on SDoH in patients with uveitis using the following keywords: "uveitis," "social determinants of health," "socioeconomic status," "education," "access to healthcare," "health literacy," "health disparities," "race/ethnicity," "gender," and "environmental factors." Case reports were excluded.

RESULTS

Fifty two articles were included. Among these, 31 addressed healthcare access (e.g. limited specialist availability, cost/insurance barriers, urban-rural gaps), 23 highlighted economic stability (e.g. low income, out-of-pocket costs, poor medication adherence), 19 discussed environment and community (e.g. higher infectious uveitis rates in resource-limited areas, lack of social support), 18 focused on racial and ethnic disparities (e.g. advanced disease at presentation, worse outcomes for African American, Hispanic, and Indigenous populations), and 15 addressed education and awareness (e.g. low health literacy, inadequate patient education materials). Nine papers examined two domains, and 10 incorporated three or more. Across domains, limited resources and knowledge were associated with delayed diagnosis, suboptimal adherence, and poorer visual outcomes.

CONCLUSION

The current literature shows a correlation between SDoH and an increased incidence and poorer disease outcomes in patients with uveitis. Further research is needed to mitigate disparities in care for patients with uveitis.

Evaluation of the Appropriateness and Readability of ChatGPT-4 Responses to Patient Queries on Uveitis

Purpose

To compare the utility of ChatGPT-4 as an online uveitis patient education resource with existing patient education websites.

Design

Evaluation of technology.

Participants

Not applicable.

Methods

The term "uveitis" was entered into the Google search engine, and the first 8 nonsponsored websites were selected to be enrolled in the study. Information regarding uveitis for patients was extracted from Healthline, Mayo Clinic, WebMD, National Eye Institute, Ocular Uveitis and Immunology Foundation, American Academy of Ophthalmology, Cleveland Clinic, and National Health Service websites. ChatGPT-4 was then prompted to generate responses about uveitis in both standard and simplified formats. To generate the simplified response, the following request was added to the prompt: 'Please provide a response suitable for the average American adult, at a sixth-grade comprehension level.' Three dual fellowship-trained specialists, all masked to the sources, graded the appropriateness of the contents (extracted from the existing websites) and responses (generated responses by ChatGPT-4) in terms of personal preference, comprehensiveness, and accuracy. Additionally, 5 readability indices, including Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook index were calculated using an online calculator, Readable.com, to assess the ease of comprehension of each answer.

Main Outcome Measures

Personal preference, accuracy, comprehensiveness, and readability of contents and responses about uveitis.

Results

A total of 497 contents and responses, including 71 contents from existing websites, 213 standard responses, and 213 simplified responses from ChatGPT-4 were recorded and graded. Standard ChatGPT-4 responses were preferred and perceived to be more comprehensive by dually trained (uveitis and retina) specialist ophthalmologists while maintaining similar accuracy level compared with existing websites. Moreover, simplified ChatGPT-4 responses matched almost all existing websites in terms of personal preference, accuracy, and comprehensiveness. Notably, almost all readability indices suggested that standard ChatGPT-4 responses demand a higher educational level for comprehension, whereas simplified responses required lower level of education compared with the existing websites.

Conclusions

This study shows that ChatGPT can provide patients with an avenue to access comprehensive and accurate information about uveitis, tailored to their educational level.

Financial Disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Readability and Suitability of Online Uveitis Patient Education Materials

PURPOSE

This study assesses readability, suitability, and accountability of online uveitis patient education materials (PEMs).

METHODS

Two uveitis specialists reviewed the top 10 websites on Google for keyword "uveitis," with a PubMed review control. Readability was assessed using an online calculator, suitability using the Suitability Assessment of Materials (SAM) tool, and accountability using JAMA benchmarks.

RESULTS

The mean SAM score was 21.05, indicating that websites were on average adequately suitable to educate patients. WebMD Uveitis website scored the highest at 25.5, while allaboutvision.org scored the lowest at 18.0. The average Flesch Reading Ease (FRE) score was 44.0 (95% CI: 34.2, 53.8). The average reading grade score was 11.0 (95% CI: 9.4, 12.6). WebMD Uveitis page scored highest on readability. The average accountability score among sites was 2.36 out of 4.

CONCLUSIONS

Uveitis websites are only adequately suitable as PEMs, and all are above the recommended reading level. Uveitis specialists should advise patients on quality of online PEMs.

Health Literacy, Medication Adherence, and Quality of Life in Patients With Uveitis

Purpose: To evaluate health literacy, medication adherence, and quality of life (QOL) in uveitis patients.Methods: Cross-sectional quality improvement study using questionnaires of health literacy (Short Assessment of Health Literacy), adherence (Beliefs about Medicine Questionnaire), and QOL (12-item Short Form Health Survey).Results: Sixty patients were surveyed: 57% women, 80% identified as Black, and 42% with schooling beyond high school. Forty-three percent of the patients had poor health literacy, with lower scores among those with less schooling (p < .01). Necessity scores were higher for multiple providers (p = .02). Necessity (p = .03) and Concerns (p < .01) scores were higher for patients seeing a rheumatologist. Patients had lower physical (p < .01) and mental QOL (p < .01) than the general US population.Conclusions: Uveitis patients reported many barriers to care. Despite strong perceptions of treatment necessity, there were significant concerns, especially among patients seeing a rheumatologist. We recommend multidisciplinary care, individualized education, and counseling regarding medication safety and the necessity to improve adherence.

Assessment of the Readability, Availability, and Quality of Online Patient Education Materials Regarding Uveitis Medications

Purpose: To assess the availability, quality, and readability of online patient education materials regarding uveitis medications.Methods: The top 10 Google search results for 10 commonly prescribed uveitis medications (prednisone, azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, chlorambucil, cyclophosphamide, adalimumab, and infliximab) were analyzed for readability and accountability. Readability was assessed with the Flesch reading ease score, Flesch-Kincaid grade level, Gunning Fog Index, Simple Measure of Gobbledygook Index, and Coleman Liau Index. JAMA benchmarks were used to assign websites accountability scores. Statistical analysis was performed with two-tailed t-tests.Results: Of 100 search results, none complied with the recommended sixth-grade reading level across all readability formulas. Only one website satisfied all 4 JAMA benchmarks, two websites were able to satisfy three benchmarks, and the remainder achieved two or less.Conclusions: Online information regarding uveitis medications lacks accountability and is not written at an appropriate level for the average patient.