A knowledge-guided agentic framework for mitigating patient-context ambiguity in health queries

Patients often submit short, underspecified queries to healthcare chatbots that lack the patient-specific information needed to determine an appropriate response. Although these queries may be linguistically clear, they can support multiple plausible answers depending on undisclosed factors such as symptoms, diagnoses, medications, allergies, or dietary restrictions. A language model answering such a query directly may therefore rely on unsupported assumptions about the patient. We introduce a knowledge-guided agentic framework for mitigating patient-context ambiguity before final response generation. The framework operates between the patient and an otherwise unchanged downstream language model. It interprets the initial query, uses a task-specific knowledge graph to construct a set of plausible hypotheses, identifies the missing patient-context variables needed to distinguish among them, and asks targeted follow-up questions. The original query and the acquired context are then combined into a clarified prompt for the downstream model. We evaluated the framework across five language models using two controlled ambiguity-mitigation benchmarks: diagnosis retrieval from 1,034 symptom queries with clinically relevant evidence systematically masked, and dietary-safety classification from 487 queries with decisive health context omitted. The framework was compared with direct answering of the underspecified query and with rephrasing the same query without acquiring new patient information. In diagnosis retrieval, it increased overall exact Top-1 accuracy by at least 57.1 percentage points and selective exact Recall@5 by at least 77.7 percentage points across the five evaluated models compared with direct prompting. In dietary-safety classification, it improved accuracy across all five models and achieved the highest Matthews correlation coefficient for four...

CCBENCH: Assessing LLM Cultural Competence via Implicitly Signaled Norms using Health Queries

To interact with users fairly and without stereotyping, AI models must display cultural competency, i.e., the ability to infer and adapt to a user's implicitly signaled cultural values, rather than relying on static demographic traits. We introduce CCBENCH, a framework for evaluating cultural competency in large language models (LLMs), treating culture as a continuum of norm adherence states rather than as a binary state of cultural belongingness. As a case study on health, we create CCBENCH-Health, which includes 60 theoretically grounded personas exhibiting varied norm-adherence states across six cultures, each engaging in 18 realistic dialogues. Each persona is evaluated on 52 authentic healthcare questions drawn from real user forums, yielding 3,120 unique interactions. Benchmarking five leading models reveals that even the best achieve culturally appropriate responses only 20-30% of the time. When explicitly prompted to focus on culturally relevant cues from the conversational history (CoT), performance improves modestly by 3-5% on average. We find that models perform best when personas avoid cultural norms rather than follow them, revealing a persistent asymmetry, suggesting a preference in the models to align with built-in biases than adapt to cultural cues. This is especially observed in the Afghan context (Avg: 8.8%), where cultural cues rarely yield appropriate health advice. Finally, we find that models sometimes adapt more readily to implicit, cultural conversational styles than to explicitly stated cultural practices, though this varies across cultures.