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Gumilar KE, Indraprasta BR, Hsu YC, Yu ZY, Chen H, Irawan B, Tambunan Z, Wibowo BM, Nugroho H, Tjokroprawiro BA, Dachlan EG, Mulawardhana P, Rahestyningtyas E, Pramuditya H, Putra VGE, Waluyo ST, Tan NR, Folarin R, Ibrahim IH, Lin CH, Hung TY, Lu TF, Chen YF, Shih YH, Wang SJ, Huang J, Yates CC, Lu CH, Liao LN, Tan M. Disparities in medical recommendations from AI-based chatbots across different countries/regions. Sci Rep 2024; 14:17052. [PMID: 39048640 PMCID: PMC11269683 DOI: 10.1038/s41598-024-67689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
This study explores disparities and opportunities in healthcare information provided by AI chatbots. We focused on recommendations for adjuvant therapy in endometrial cancer, analyzing responses across four regions (Indonesia, Nigeria, Taiwan, USA) and three platforms (Bard, Bing, ChatGPT-3.5). Utilizing previously published cases, we asked identical questions to chatbots from each location within a 24-h window. Responses were evaluated in a double-blinded manner on relevance, clarity, depth, focus, and coherence by ten experts in endometrial cancer. Our analysis revealed significant variations across different countries/regions (p < 0.001). Interestingly, Bing's responses in Nigeria consistently outperformed others (p < 0.05), excelling in all evaluation criteria (p < 0.001). Bard also performed better in Nigeria compared to other regions (p < 0.05), consistently surpassing them across all categories (p < 0.001, with relevance reaching p < 0.01). Notably, Bard's overall scores were significantly higher than those of ChatGPT-3.5 and Bing in all locations (p < 0.001). These findings highlight disparities and opportunities in the quality of AI-powered healthcare information based on user location and platform. This emphasizes the necessity for more research and development to guarantee equal access to trustworthy medical information through AI technologies.
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Affiliation(s)
- Khanisyah E Gumilar
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia.
| | - Birama R Indraprasta
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Yu-Cheng Hsu
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Zih-Ying Yu
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC
| | - Hong Chen
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Budi Irawan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Zulkarnain Tambunan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Bagus M Wibowo
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Hari Nugroho
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Brahmana A Tjokroprawiro
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Erry G Dachlan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Pungky Mulawardhana
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia
| | - Eccita Rahestyningtyas
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia
| | - Herlangga Pramuditya
- Department of Obstetrics and Gynecology, Dr. Ramelan Naval Hospital, Surabaya, Indonesia
| | - Very Great E Putra
- Department of Obstetrics and Gynecology, Dr. Kariadi Central General Hospital, Semarang, Indonesia
| | - Setyo T Waluyo
- Department of Obstetrics and Gynecology, Ulin General Hospital, Banjarmasin, Indonesia
| | - Nathan R Tan
- Department of Modern and Classical Languages and Literature, University of South Alabama, Mobile, AL, USA
| | - Royhaan Folarin
- Department of Anatomy, Faculty of Basic Medical Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Ibrahim H Ibrahim
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Cheng-Han Lin
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Tai-Yu Hung
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Ting-Fang Lu
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Yen-Fu Chen
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Shao-Jing Wang
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Jingshan Huang
- School of Computing and College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Clayton C Yates
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC.
| | - Li-Na Liao
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC.
| | - Ming Tan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
- Institute of Biochemistry and Molecular Biology, Graduate Institute of Biomedical Sciences, China Medical University (Taiwan), No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC.
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García-Egea A, Holst AS, Jacques-Aviñó C, Martínez-Bueno C, Berenguera A, Vicente-Hernández MM, Valls-Llobet C, Pinzón-Sanabria D, Pujolar-Díaz G, Medina-Perucha L. Perspectives on menstrual policymaking and community-based actions in Catalonia (Spain): a qualitative study. Reprod Health 2024; 21:1. [PMID: 38178256 PMCID: PMC10768382 DOI: 10.1186/s12978-023-01730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Menstrual research and policymaking have become imperative worldwide. It is necessary that these are informed by women and people who menstruate (PWM) alongside expert professionals and activists. METHODS The main aim of this study was to identify and propose policies and community-based actions to address menstrual inequity and promote menstrual health in Catalonia (Spain). This study consisted of two qualitative studies: (a) 34 individual photoelicitation interviews with women and PWM, (b) a World Café study with 22 professionals and activists. Sampling for both studies was purposive and selective. Recruitment was conducted through healthcare centres, social media, key contacts, and snowball sampling techniques. Data were collected in December 2020-September 2022, and analysed using Framework Analysis. RESULTS Participants considered the implementation of menstrual policies that address the taboo and stigma of menstruation to be crucial. They stressed the need for menstrual education, which should be integrated into formal education curricula. Participants, and especially women and PWM, highlighted the need to improve the access and quality of healthcare services, so that the menstrual cycle and menstruation are seen as health indicators. Health professionals should encourage agentic informed decisions, hence why both participant groups considered menstrual health education amongst health professionals to be pivotal. Taking action to improve the access and affordability of menstrual products was also imperative for participants, especially for socioeconomically vulnerable populations. Participants agreed on guaranteeing fully equipped menstrual management facilities, and and professionals discussed gender-neutral and sex-segregated bathrooms. Workplace menstrual policies to accommodate and ensure menstrual self-care were also suggested. CONCLUSIONS Our study highlights the need for multi-dimensional menstrual policies. These should include actions to address menstrual taboo and stigma, to promote menstrual education that goes beyond the hegemonic biomedical prism, to improve the access and quality of menstrual health services, along with policies ensuring adequate menstrual management facilities in public spaces and the access to menstrual products. Policymaking should also focus on how to ensure menstrual management and care in workplaces. Menstrual policies and community-based actions should be framed within intersectionality, to consider how societal structures of power and oppression influence menstrual experiences.
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Affiliation(s)
- Andrea García-Egea
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587 attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Anna Sofie Holst
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587 attic, 08007, Barcelona, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587 attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Cristina Martínez-Bueno
- Servei d'Atenció a la Salut Sexual i Reproductiva (ASSIR), Direcció Assistencial d'Atenció Primària, Institut Català de la Salut, Barcelona, Spain
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587 attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
| | | | | | | | - Georgina Pujolar-Díaz
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587 attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Laura Medina-Perucha
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587 attic, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain.
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Schultz S, Zorbas C, Peeters A, Yoong S, Backholer K. Strengthening local government policies to address health inequities: perspectives from Australian local government stakeholders. Int J Equity Health 2023; 22:119. [PMID: 37344850 DOI: 10.1186/s12939-023-01925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND With their close connection to community and increasing preventive health remit, local governments are well positioned to implement policies and programs to address health inequities. Nevertheless, there is a lack of evidence of equity-focused policy action in this sector. We aimed to understand how local government representatives approach equity in the development and implementation of health and wellbeing policies and programs, and to identify potential enablers for strengthening an equity focus. METHODS We conducted semi-structured interviews (June 2022-January 2023) with 29 health directorate representatives from 21 local governments in Victoria, Australia. Representatives were recruited from urban, regional and rural local government areas, with varying levels of socioeconomic position. Data was analysed inductively using Braun and Clarke's reflexive thematic analysis, informed by social determinants of health theory and a public policy decision making framework. RESULTS Local governments approach health equity in different ways including focusing on priority populations, disadvantaged geographic areas, or by targeting the upstream determinants of health, such as housing and employment. Enabling factors for more equity-oriented local government policy action included those internal to local governments: (i) having a clear conceptualisation of equity, (ii) fostering a strong equity-centric culture, and (iii) developing organisational-wide competency in health equity. External factors related to key stakeholder groups that support and/or influence local governments included: (iv) strong support from community, (v) state government leadership and legislation, and (vi) supportive local partners, networks and NGO's. CONCLUSIONS Local governments have a responsibility to implement policies and programs that improve health and reduce health inequities. Local government's capacity to leverage resources, structures, processes and relationships, internally and across sectors and community, will be key to strengthening equity-oriented local government health policies and programs.
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Affiliation(s)
- Sally Schultz
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Christina Zorbas
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Serene Yoong
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kathryn Backholer
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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