Consumer Attitudes Towards AI in Digital Health: A Mixed-Methods Survey in Australia

Artificial intelligence (AI) is increasingly integrated into healthcare to support diagnostics, decision-making, and administrative processes. However, the successful implementation of AI depends not only on technical performance but also on public perceptions of its helpfulness, riskiness, and fairness. This study examines public perceptions of automated decision-making (ADM) in healthcare. Data were drawn from the first wave of an ongoing longitudinal survey panel. The final sample consisted of 3,915 respondents and was analyzed with structural equation modeling. Perceptions of ADM in healthcare as helpful, risky, and fair were treated as the dependent variables. AI literacy, familiarity with different forms of AI, confidence in clinicians' ability to distinguish AI- from human-generated content, use of conversational agents for health information, and use of traditional digital health information sources were included as exogenous. Greater familiarity with different forms of AI, higher confidence in the clinician's ability to recognize AI-generated content, and use of conversational agents for health information were associated with greater perceived helpfulness. Use of conversational agents was associated with lower perceived risk, whereas greater familiarity with AI and greater reliance on traditional health information sources were associated with higher perceived risk. Perceptions of ADM as fair were most strongly predicted by confidence in the clinician's ability, with additional small positive associations with AI familiarity, AI literacy, and use of conversational agents. Public perceptions of ADM in healthcare are shaped by technological familiarity, use of conversational agents, and confidence in human oversight. Overall, ADM's perceived helpfulness and fairness are driven more by trust in healthcare professionals than by trust in the technology itself.

Background: Generative artificial intelligence (GenAI) is increasingly used for health information, yet its influence on users' trust calibration remains unclear. Objective: This study examines whether learned dependency on GenAI influences trust in AI-generated health information and whether text highlighting reduces overreliance on incorrect outputs. Methods: Two randomized controlled experiments were conducted with 338 college students and 563 Amazon Mechanical Turk participants. Both experiments used a 2 by 2 between-subjects design manipulating information accuracy (correct versus incorrect) and text highlighting (highlight versus no highlight). Trust and learned dependency were measured using validated scales, and linear regression models tested main and interaction effects. Results: In both experiments, information accuracy significantly increased trust (p < 0.001), while learned dependency was positively associated with trust (p < 0.05). The interaction between accuracy and dependency was significant (p < 0.001), indicating that highly dependent users were more likely to trust incorrect AI-generated information. Text highlighting had no significant effect on trust and did not moderate the relationship between dependency and trust. Conclusions: Learned dependency weakens trust calibration, increasing susceptibility to inaccurate AI-generated health information. Text highlighting alone is insufficient to reduce overreliance, highlighting the need for more effective interface designs that encourage critical evaluation of GenAI outputs.

Objective: This study develops and validates a patient simulation framework that aligns with the National Institute of Standards and Technology AI Risk Management Framework MAP and MEASURE functions, providing an empirical basis for identifying and characterizing performance risks in conversational clinical AI across medical, linguistic, and behavioral patient variation. We applied the framework to a conversational decision aid for antidepressant selection in major depressive disorder. Methods: The simulator integrates three profile dimensions: (1) medical profiles constructed from All of Us electronic health records using risk-ratio gating; (2) linguistic profiles modeling a health literacy gradient and condition-specific communication; and (3) behavioral profiles representing cooperative, distracted, and adversarial engagement. We generated 500 simulated conversations and evaluated profile fidelity through human annotation and a large language model (LLM) judge, then assessed downstream effects on the AI Decision Aid's concept retrieval and antidepressant recommendations. Results: The patient simulator expressed medical concepts with high fidelity (96.6% accurate across 8,210 concepts), with human inter-annotator agreement of 0.73$κ$ and LLM-judge agreement against human annotators of 0.78$κ$, both indicating substantial agreement. Behavioral profiles were reliably distinguished (0.93$κ$, near perfect agreement), and linguistic profiles showed substantial agreement at the lower bound of the substantial range (0.61$κ$), adequate to support profile-level analysis. The framework revealed monotonic degradation in AI Decision Aid performance across the health literacy gradient. Rank-1 concept retrieval increased from 47.6% for limited health literacy to 81.9% for proficient health literacy, with corresponding declines in antidepressant recommendation accuracy.