HerHealthEval: Evaluating Multilingual and Register-Sensitive Understanding of Women's Health Communication

Abstract

Large language models are increasingly used in healthcare communication, yet most evaluations emphasize response quality while assuming that the user's concern has been interpreted correctly. We introduce HerHealthEval, a controlled evaluation framework for multilingual understanding of women's-health communication. For each clinical case, HerHealthEval provides matched versions in English, French, and Modern Standard Arabic using six communicative forms: canonical, clinical, layperson, indirect or hedged, emotionally concerned, and deliberately under-specified. The first five express the same underlying concern and retain the same clinical information, whereas the under-specified form intentionally omits relevant details to test whether the model recognizes that clarification is needed. We evaluate a multilingual instruction model and QLoRA-adapted variants on concern classification, risk calibration, clarification behavior, parse compliance, and cross-form consistency. Results reveal that aggregate accuracy and consistency can conceal safety-relevant failures. A multilingual adaptation model reaches 0.994 under-triage in French and Arabic under language-asymmetric risk supervision. A controlled re-adaptation using source-derived, language-invariant risk labels reduces under-triage to 0.572 and 0.558, respectively. These findings show that robust multilingual healthcare evaluation requires explicit testing of register variation, uncertainty handling, and the provenance and invariance of adaptation labels.