Acceptability of artificial intelligence (AI)-enabled chatbots, video consultations and live webchats as online platforms for sexual health advice

OBJECTIVES

Sexual and reproductive health (SRH) services are undergoing a digital transformation. This study explored the acceptability of three digital services, (i) video consultations via Skype, (ii) live webchats with a health advisor and (iii) artificial intelligence (AI)-enabled chatbots, as potential platforms for SRH advice.

METHODS

A pencil-and-paper 33-item survey was distributed in three clinics in Hampshire, UK for patients attending SRH services. Logistic regressions were performed to identify the correlates of acceptability.

RESULTS

In total, 257 patients (57% women, 50% aged <25 years) completed the survey. As the first point of contact, 70% preferred face-to-face consultations, 17% telephone consultation, 10% webchats and 3% video consultations. Most would be willing to use video consultations (58%) and webchat facilities (73%) for ongoing care, but only 40% found AI chatbots acceptable. Younger age (<25 years) (OR 2.43, 95% CI 1.35 to 4.38), White ethnicity (OR 2.87, 95% CI 1.30 to 6.34), past sexually transmitted infection (STI) diagnosis (OR 2.05, 95% CI 1.07 to 3.95), self-reported STI symptoms (OR 0.58, 95% CI 0.34 to 0.97), smartphone ownership (OR 16.0, 95% CI 3.64 to 70.5) and the preference for a SRH smartphone application (OR 1.95, 95% CI 1.13 to 3.35) were associated with video consultations, webchats or chatbots acceptability.

CONCLUSIONS

Although video consultations and webchat services appear acceptable, there is currently little support for SRH chatbots. The findings demonstrate a preference for human interaction in SRH services. Policymakers and intervention developers need to ensure that digital transformation is not only cost-effective but also acceptable to users, easily accessible and equitable to all populations using SRH services.

A Novel Insight Into the Challenges of Diagnosing Degenerative Cervical Myelopathy Using Web-Based Symptom Checkers

Background

Degenerative cervical myelopathy (DCM) is a common debilitating condition resulting from degeneration of the cervical spine. While decompressive surgery can halt disease progression, existing spinal cord damage is often permanent, leaving patients with lifelong disability. Early surgery improves the likelihood of recovery, yet the average time from the onset of symptoms to correct diagnosis is over 2 years. The majority of delays occur initially, before and within primary care, mainly due to a lack of recognition. Symptom checkers are widely used by patients before medical consultation and can be useful for preliminary triage and diagnosis. Lack of recognition of DCM by symptom checkers may contribute to the delay in diagnosis.

Objective

The aims of this study were to investigate whether Web-based symptom checkers were able to recognize relevant symptoms of DCM, to characterize the DCM differential they returned , and to evaluate the diagnostic performance of recognized DCM symptoms.

Methods

We pooled classical DCM symptoms from leading review articles. These symptoms were entered into the algorithms used by the top 20 symptom checker websites (N=4; Google Search). The most widely cited symptom checker, WebMD, was used to characterize the differential diagnosis for DCM symptoms.

Results

A total of 31 classical DCM symptoms were identified, of which 45% (14/31) listed DCM as a differential and 10% (3/31) placed DCM in the top third of the differential. The mean differential rank for motor symptoms was significantly better than that for arthritic symptoms (P=.01) and the average differential rank for all symptoms (P=.048). The symptom checker WebMD performed best at recognizing DCM, placing the condition nearer to the top of the differential list (mean rank of 5.6) than either Healthline (rank of 12.9, P=.02) or Healthtools.AARP (rank of 15.5, P=.001). On WebMD, only one combination of symptoms resulted in DCM as the primary differential: neck, shoulder, and arm pain with hand weakness. Moreover, 151 differential diagnoses for DCM symptoms were recorded on WebMD. Multiple sclerosis and peripheral neuropathy were the most common differentials, shortlisted for 52% (16/31) and 32% (10/31) of the DCM symptoms, respectively.

Conclusions

DCM symptoms are poorly identified by Web-based symptom checkers, which leads to a large differential of many other common conditions. While a diagnosis becomes more likely as the number of symptoms increases, this represents more advanced disease and will not support much-needed earlier diagnosis. Symptom checkers remain an attractive concept with potential. Further research is required to support their optimization.

Shifting white pox aetiologies affecting Acropora palmata in the Florida Keys, 1994-2014

We propose 'the moving target hypothesis' to describe the aetiology of a contemporary coral disease that differs from that of its historical disease state. Hitting the target with coral disease aetiology is a complex pursuit that requires understanding of host and environment, and may lack a single pathogen solution. White pox disease (WPX) affects the Caribbean coral Acropora palmata. Acroporid serratiosis is a form of WPX for which the bacterial pathogen (Serratia marcescens) has been established. We used long-term (1994-2014) photographic monitoring to evaluate historical and contemporary epizootiology and aetiology of WPX affecting A. palmata at eight reefs in the Florida Keys. Ranges of WPX prevalence over time (0-71.4%) were comparable for the duration of the 20-year study. Whole colony mortality and disease severity were high in historical (1994-2004), and low in contemporary (2008-2014), outbreaks of WPX. Acroporid serratiosis was diagnosed for some historical (1999, 2003) and contemporary (2012, 2013) outbreaks, but this form of WPX was not confirmed for all WPX cases. Our results serve as a context for considering aetiology as a moving target for WPX and other coral diseases for which pathogens are established and/or candidate pathogens are identified. Coral aetiology investigations completed to date suggest that changes in pathogen, host and/or environment alter the disease state and complicate diagnosis.

Internet self-diagnosis in hand surgery

BACKGROUND

Some Internet sites have programs that attempt to help patients find their diagnosis based on symptoms. This study tested the null hypothesis that there are no factors associated with correspondence between online diagnosis and the hand surgeon's diagnosis in an outpatient hand and upper extremity surgeons' office.

METHODS

Eighty-six outpatients were prospectively enrolled and used WebMD® symptom checker to guess their diagnosis. We collected demographic information, hours spent on the Internet per week, and the following questionnaires: Pain Catastrophizing Scale (PCS) and Center of Epidemiologic Studies Depression scale (C-ESD).

RESULTS

Thirty-three percent of online diagnoses matched the final diagnosis of the hand surgeon. Factors associated with an online diagnosis corresponding to the hand surgeon's diagnosis included sex (women) and patients who studied their symptoms online prior to the visit. The best multivariable model included sex, more years of education, and prior use of the Internet to research their medical condition and explained 15 % of the variation in correspondence of diagnosis.

CONCLUSIONS

The majority of online diagnoses for hand and upper extremity conditions do not correspond with the diagnosis of the treating hand surgeon. Psychological factors do not influence the correspondence of online diagnosis with the hand surgeon's diagnosis.

LEVEL OF EVIDENCE

Prognostic, level II.

[Health information on the Internet: Who is searching for what, when and how?]

INTRODUCTION

The Institute for Quality and Efficiency in Health Care (IQWiG, Germany) has a statutory mandate to provide patients and their family members as well as the wider public with evidence-based health information (www.informedhealthonline.org). Since 2006 IQWiG has maintained the publicly available website gesundheitsinformation.de. Currently, about 80 million people live in Germany, and the majority of them have internet access. The goal of this project was to evaluate published studies examining health information seeking behaviour (who, when and how) on the internet.

METHODS

A systematic search was conducted in several databases (PubMed, MEDLINE [Ovid)], PsycInfo [Ovid] und CINAHL [Ebsco]) for studies on internet searches for health information. No study type restrictions were imposed. Data were extracted from the relevant studies, and then discussed in the project group and summarised qualitatively.

RESULTS

Of the 1,150 abstracts identified, 169 publications were analysed in full. 74 studies were included, most of which were surveys (n=59). The data were extracted from these studies and then summarised qualitatively to obtain an overview of the current state of research in this field. The results suggest that the group most often searching for health-related information on the internet - either on their own behalf or on behalf of others - consists of middle-aged women with a higher level of education and income. The most common reason for initiating a search for health information is a visit to the doctor, and the most common starting point is a search engine. Page layout and user-friendliness are the main criteria for assessing the credibility of websites and the information they provide. Users are more likely to trust information that is consistent with their own experiences and opinions.

DISCUSSION

There is a growing trend of using the internet as a source for health information. It seems that trust in the credibility of a given website or information mostly depends on factors that are hardly related to the quality of content. This may pose a particular challenge for the creation and dissemination of evidence-based health information. Further research is required to examine the needs of the individual groups using internet-based health information.

Quality of vascular surgery Web sites on the Internet

INTRODUCTION

This study evaluated the readability, accessibility, usability, and reliability of vascular surgery information on the Internet in the English language.

METHODS

The Google, Yahoo, and MSN/Bing search engines were searched for "carotid endarterectomy," "EVAR or endovascular aneurysm repair," and "varicose veins or varicose veins surgery." The first 50 Web sites from each search engine for each topic were analyzed. The Flesch Reading Ease Score and Gunning Fog Index were calculated to assess readability. The LIDA tool (Minervation Ltd, Oxford, UK) was used to assess accessibility, usability, and reliability.

RESULTS

The Web sites were difficult to read and comprehend. The mean Flesch Reading Ease scores were 53.53 for carotid endarterectomy, 50.53 for endovascular aneurysm repair, and 58.59 for varicose veins. The mean Gunning Fog Index scores were 12.3 for carotid endarterectomy, 12.12 for endovascular aneurysm repair, and 10.69 for varicose veins. The LIDA values for accessibility were good, but the results for usability and reliability were poor.

CONCLUSIONS

Internet information on vascular surgical conditions and procedures is poorly written and unreliable. We suggest that health professionals should recommend Web sites that are easy to read and contain high-quality surgical information. Medical information on the Internet must be readable, accessible, usable, and reliable.