Evidence-Based Medicine

Research Appraisals

Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.

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Randomised Controlled TrialEvidence: Weak
50CEBM

PloS one

Evaluating the cultural alignment of multilingual LLMs in typical Japanese workplace scenarios

While current evaluations of LLM cultural alignment predominantly rely on static benchmarks in Western contexts, their ability to navigate generative, high-context socio-pragmatic demands in non-Western environments remains critically underexplored. This study investigates how multilingual LLMs adapt to the Japanese workplace-a stringent stress-test environment characterized by strong high-context communication norms and rigid honorific conventions-using Hofstede's six cultural dimensions as a heuristic framework. We evaluated five state-of-the-art LLMs (LLM-jp, Phi, Llama, Qwen, and GLM) through a large-scale crowdsourced human evaluation. Based on 1,718 valid evaluator sessions, native Japanese raters assessed model outputs to generate a holistic Japanese Workplace Cultural Alignment Score (JWCAS). To dissect the underlying communicative strategies, we paired this with a three-layer diagnostic sub-score analysis (Linguistic Form, Socio-Cultural Values, and Social Action). Our results reveal that leading multilingual models (Phi and GLM) achieved overall JWCAS scores comparable to, or significantly higher than, the native Japanese model (LLM-jp). Crucially, our sub-score analysis demonstrates that holistic evaluation metrics can obscure deep pragmatic deficits: while LLM-jp overfits to surface-level linguistic politeness (Layer 1), it shows critical weaknesses in socio-cultural values (Layer 2) and context-aware social strategies (Layer 3). In contrast, leading multilingual models demonstrate balanced competence across all layers. These findings suggest that true cultural competence requires moving beyond native linguistic mastery, highlighting the necessity of multi-dimensional diagnostic frameworks for cross-cultural AI alignment.

29 July 2026

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otherEvidence: Moderate
85CEBM

JMIR human factors

Chatbot Usability Scale in Chinese Users: Cross-Cultural Adaptation and Validation Study

BACKGROUND: Chatbots are increasingly deployed across various domains; however, systematic evaluation of their usability remains limited, particularly in non-Western contexts. The 11-item Chatbot Usability Scale (BUS-11), a multidimensional instrument grounded in human-computer interaction theory, has demonstrated strong psychometric properties in prior studies; however, a validated Chinese version does not exist, despite China being one of the largest chatbot markets. OBJECTIVE: This study aimed to translate, culturally adapt, and validate the BUS-11 for Chinese users. METHODS: Following established cross-cultural adaptation procedures, the scale was forward- and back-translated, reviewed by an expert committee, and pilot-tested for clarity and feasibility. A main validation study was then conducted with 214 participants, who completed 438 evaluations of the chatbots across 10 widely used systems. RESULTS: Psychometric analyses demonstrated excellent scale-level content validity index (ie, 0.92), strong internal consistency (Cronbach α=0.92), and a clear 3-factor structure (Accessibility, Interaction Process Quality, and Information Quality), explaining 56.1% of the variance. Meanwhile, privacy or security and response time were retained as single-item indicators. The Chinese BUS-11 was concise, user-friendly, and psychometrically robust. CONCLUSIONS: This work fills a critical gap by providing the first validated instrument for assessing chatbot usability in Chinese contexts, enabling reliable cross-cultural comparisons and supporting both research and practical design evaluation in human-computer interaction.

7 Apr 2026

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