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      Assessing the Quality of Patient Education Materials on Cardiac Catheterization From Artificial Intelligence Chatbots: An Observational Cross-Sectional Study

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          Abstract

          Background

          Health literacy empowers patients to participate in their own healthcare. Personal health literacy is one’s ability to find, understand, and use information/resources to make well-informed health decisions. Artificial intelligence (AI) has become a source for the acquisition of health-related information through large language model (LLM)-driven chatbots. Assessment of the readability and quality of health information produced by these chatbots has been the subject of numerous studies to date. This study seeks to assess the quality of patient education materials on cardiac catheterization produced by AI chatbots.

          Methodology

          We asked a set of 10 questions about cardiac catheterization to four chatbots: ChatGPT (OpenAI, San Francisco, CA), Microsoft Copilot (Microsoft Corporation, Redmond, WA), Google Gemini (Google DeepMind, London, UK), and Meta AI (Meta, New York, NY). The questions and subsequent answers were utilized to make patient education materials on cardiac catheterization. The quality of these materials was assessed using two validated instruments for patient education materials: DISCERN and the Patient Education Materials Assessment Tool (PEMAT).

          Results

          The overall DISCERN scores were 4.5 for ChatGPT, 4.4 for Microsoft Copilot and Google Gemini, and 3.8 for Meta AI. ChatGPT, Microsoft Copilot, and Google Gemini tied for the highest reliability score at 4.6, while Meta AI had the lowest with 4.2. ChatGPT had the highest quality score at 4.4, while Meta AI had the lowest with 3.4. ChatGPT and Google Gemini had Understandability scores of 100%, while Meta AI had the lowest with 82%. ChatGPT, Microsoft Copilot, and Google Gemini all had Actionability scores of 75%, while Meta AI had one of 50%.

          Conclusions

          ChatGPT produced the most reliable and highest quality materials, followed closely by Google Gemini. Meta AI produced the lowest quality materials. Given the easy accessibility that chatbots provide patients and the high-quality responses that we obtained, they could be a reliable source for patients to obtain information about cardiac catheterization.

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          Most cited references18

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          Low health literacy and health outcomes: an updated systematic review.

          Approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes. To update a 2004 systematic review and determine whether low health literacy is related to poorer use of health care, outcomes, costs, and disparities in health outcomes among persons of all ages. English-language articles identified through MEDLINE, CINAHL, PsycINFO, ERIC, and Cochrane Library databases and hand-searching (search dates for articles on health literacy, 2003 to 22 February 2011; for articles on numeracy, 1966 to 22 February 2011). Two reviewers independently selected studies that compared outcomes by differences in directly measured health literacy or numeracy levels. One reviewer abstracted article information into evidence tables; a second reviewer checked information for accuracy. Two reviewers independently rated study quality by using predefined criteria, and the investigative team jointly graded the overall strength of evidence. 96 relevant good- or fair-quality studies in 111 articles were identified: 98 articles on health literacy, 22 on numeracy, and 9 on both. Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer ability to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Poor health literacy partially explains racial disparities in some outcomes. Reviewers could not reach firm conclusions about the relationship between numeracy and health outcomes because of few studies or inconsistent results among studies. Searches were limited to articles published in English. No Medical Subject Heading terms exist for identifying relevant studies. No evidence concerning oral health literacy (speaking and listening skills) and outcomes was found. Low health literacy is associated with poorer health outcomes and poorer use of health care services. Agency for Healthcare Research and Quality.
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            • Article: not found

            Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information.

            To develop a reliable and valid instrument to assess the understandability and actionability of print and audiovisual materials.
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              What is the meaning of health literacy? A systematic review and qualitative synthesis

              The objective of this review was to clarify what health literacy represents. A systematic review with qualitative syntheses was performed (CRD42017065149). Studies concerning health literacy in all settings were included. Studies before 15 March 2017 were identified from PubMed, Medline, Embase, Web of Science, Scopus, PsycARTICLES and the Cochrane Library. The included literature either had defined the concept of health literacy or made a detailed explanation of health literacy. A total of 34 original studies met the inclusion criteria, including 13 involved in previous systematic reviews and 21 new studies. Health literacy was commonly conceptualised as a set of knowledge, a set of skills or a hierarchy of functions (functional-interactive-critical). The construct of health literacy covers three broad elements: (1) knowledge of health, healthcare and health systems; (2) processing and using information in various formats in relation to health and healthcare; and (3) ability to maintain health through self-management and working in partnerships with health providers. Health literacy is defined as the ability of an individual to obtain and translate knowledge and information in order to maintain and improve health in a way that is appropriate to the individual and system contexts. This definition highlights the diversity of needs from different individuals and the importance of interactions between individual consumers, healthcare providers and healthcare systems.

                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                23 September 2024
                September 2024
                : 16
                : 9
                : e69996
                Affiliations
                [1 ] Department of Internal Medicine, Sarasota Memorial Hospital, Sarasota, USA
                [2 ] Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, USA
                Author notes
                Benjamin J. Behers bjb14@ 123456med.fsu.edu
                Article
                10.7759/cureus.69996
                11498076
                39445289
                fc7ff3d4-2e1d-4d25-ab38-3cd658fe373f
                Copyright © 2024, Behers et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 September 2024
                Categories
                Cardiology
                Public Health

                cardiac catheterization,chatgpt,google gemini,meta ai,microsoft copilot,patient education

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