To evaluate the effects of iDecide on prostate cancer knowledge, informed decision-making self-efficacy, technology use self-efficacy, and intention to engage in informed decision-making among African American men.
Design:
One-group, pretest/posttest.
Setting:
Community settings in South Carolina.
Participants:
African American men, ages 40 years +, without a prior prostate cancer diagnosis (n = 354).
Intervention:
iDecide, an embodied conversational agent-led, computer-based prostate cancer screening decision aid.
Measures:
Prostate cancer knowledge, informed decision-making self-efficacy, technology use self-efficacy, and intention to engage in informed decision-making.
Analysis:
Descriptive statistics, paired t tests, general linear modeling, Spearman correlations.
Results:
On average, participants experienced significant improvements in their prostate cancer knowledge (P ≤ .001), informed decision-making self-efficacy (P ≤ .001), and technology use self-efficacy (P ≤ .001), postintervention. Additionally, 67% of participants reported an intention to engage in informed decision-making.
Conclusion:
Given the significant improvements across all measures, this research demonstrates that embodied conversational agent-led decision aids can be used to enhance the capacity for making informed prostate cancer screening decisions among African American men and increase their technology use self-efficacy. One critical limitation of this study is that most men had received prostate cancer screening prior to engaging in our intervention, so the implications of this intervention may be different for men who do not have a history of screening. Additionally, actual engagement in informed decision-making postintervention was not assessed.
SiegelRLMillerKDJemalA. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30. doi:10.3322/caac.21332.
2.
HebertJRDaguiseVGHurleyDM. Mapping cancer mortality-to-incidence ratios to illustrate racial and gender disparities in a high-risk population. Cancer. 2009;115(11):2539–2552. doi:10.1002/cncr.24270.
3.
MoyerVA; US Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(2):120–134. doi:10.7326/0003-4819-157-2-201207170-00459.
4.
CarlssonSVickersAJRoobolM. Prostate cancer screening: facts, statistics, and interpretation in response to the US Preventive Services Task Force review. J Clin Oncol. 2012;30(21):2581–2584. doi:10.1200/JCO.2011.40.4327.
5.
SchröderFH. Stratifying risk—The U.S. Preventive Services Task Force and prostate-cancer screening. N Engl J Med. 2011;365(21):1953–1955. doi:10.1056/NEJMp1112140.
6.
BrettASAblinRJ. Prostate-cancer screening—what the US Preventive Services Task Force left out. N Engl J Med. 2011;365(21):1949–1951. doi:10.1056/NEJMp1112191.
7.
CatalonaWJ. The United States preventive services task force recommendation against prostate-specific antigen screening—counterpoint. Cancer Epidemiol Biomarkers Prev. 2012;21(3):395–397. doi:10.1158/1055-9965.
US Department of Health and Human Services. Prostate Cancer Screening: A Decision Guide for African American Men. Washington, DC: US Department of Health and Human Services; 2003.
10.
WelchHGAlbertsenPC. Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986-2005. J Natl Cancer Inst. 2009;101(9):1325–1329. PMCID:2758309.
11.
SandhuGSAndrioleGL. Overdiagnosis of prostate cancer. J Natl Cancer Inst Monogr. 2012;2012(45):146–151.
12.
AndrioleGLCrawfordEDGrubbRLIII. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360(13):1310–1319. doi:10.1056/NEJMoa0810696.
13.
BarryMJ. Screening for prostate cancer—the controversy that refuses to die. N Engl J Med. 2009;360(13):1351–1354. doi:10.1056/NEJMe090116614.
14.
SchröderFHHugossonJRoobolMJ; ERSPC Investigators. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320–1328.
15.
American Cancer Society. Prostate Cancer: Early Detection. Atlanta, GA: American Cancer Society; 2013.
16.
CarterHBAlbertsenPCBarryMJ. Early detection of prostate cancer: AUA Guideline. J Urol. 2013;190(2):419–426. doi:10.1016/j.juro.2013.04.119.
17.
Bibbins-DomingoKGrossmanDCCurrySJ. The US Preventive Services Task Force 2017 draft recommendation statement on screening for prostate cancer: an invitation to review and comment. JAMA. 2017;317(19):1949–1950. doi:10.1001/jama.2017.4413.
18.
OwensOLJacksonDDThomasTL. Prostate cancer knowledge and decision making among African-American men and women in the southeastern United States. Int J Mens Health. 2015;14:55–70. PMCID:PMC4505933.
19.
LeporeSJWolfRLBaschCE. Informed decision making about prostate cancer testing in predominantly immigrant black men: a randomized controlled trial. Ann Behav Med. 2012;44(3):320–330. doi:10.1007/s12160-012-9392-3.
20.
SheridanSLGolinCBuntonA. Shared decision making for prostate cancer screening: the results of a combined analysis of two practice-based randomized controlled trials. BMC Med Inform Decis Mak. 2012;12(1):130. doi:10.1186/1472-6947-12-130.
21.
WilliamsRMDavisKMLutaG. Fostering informed decisions: a randomized controlled trial assessing the impact of a decision aid among men registered to undergo mass screening for prostate cancer. Patient Educ Couns. 2013;91(3):329–336. doi:10.1016/j.pec.2012.12.013.
22.
DrakeBFSheltonRCGilliganTAllenJD. A church-based intervention to promote informed decision making for prostate cancer screening among African American men. J Natl Med Assoc. 2010;102(3):164–171.
23.
AllenJDMohllajeeAPSheltonRCDrakeBFMarsDR. A computer-tailored intervention to promote informed decision making for prostate cancer screening among African American men. Am J Mens Health. 2009;3(4):340–351. doi:10.1177/1557988308325460.
24.
DhillonPGrivasPRaskaP. Informed decision making (IDM) for prostate cancer (PCa) screening in a high-risk population. J Clin Oncol. 2017;35(suppl 6):112–112. doi:10.1200/JCO.2017.35.6_suppl.112.
25.
UkoliFAPatelKHargreavesM. A tailored prostate cancer education intervention for low-income African Americans: impact on knowledge and screening. J Health Care Poor Underserved. 2013;24(1):311–331. doi:10.1353/hpu.2013.0033.
26.
JacksonDDOwensOLFriedmanDBDubose-MorrisR. Innovative and community-guided evaluation and dissemination of a prostate cancer education program for African-American men and women. J Cancer Educ. 2015;30(4):779–785. doi:10.1007/s13187-014-0774-z.
27.
JacksonDDOwensOLFriedmanDBHebertJR. An intergenerational approach to prostate cancer education: findings from a pilot project in the southeastern USA. J Cancer Educ. 2014;29(4):649–656. doi:10.1007/s13187-014-0618-x.
28.
RossLDarkTOromH. Patterns of information behavior and prostate cancer knowledge among African-American men. J Cancer Educ. 2011;26(4):708–716. doi:10.1007/s13187-011-0241-z.
29.
HawleySTMorrisAM. Cultural challenges to engaging patients in shared decision making. Patient Educ Couns. 2017;100(1):18–24. doi:10.1016/j.pec.2016.07.008.
30.
CarpenterWRGodleyPAClarkJA. Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use. Cancer. 2009;115(21):5048–5059. doi:10.1002/cncr.2453
31.
O’ConnorAM. User Manual—Decision Self-Efficacy Scale. Ottawa, Ontario, Canada: Ottawa Hospital Research Institute; 1995.
32.
Institute of Medicine, Committee on Health Literacy, Board of Neuroscience and Behavioral Health. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press; 2004.
33.
EllisonGLWeinrichSPLouMXuHPowellIJBaquetCR. A randomized trial comparing web-based decision aids on prostate cancer knowledge for African-American men. J Natl Med Assoc. 2008;100(10):1139–1145.
34.
EvansRJoseph-WilliamsNEdwardsA. Supporting informed decision making for prostate specific antigen (PSA) testing on the web: an online randomized controlled trial. J Med Internet Res. 2010;12(3):e27. doi:10.2196/jmir.1305.
35.
KassanECWilliamsRMKellySP. Men’s use of an internet-based decision aid for prostate cancer screening. J Health Commun. 2012;17(6):677–697. doi:10.1080/10810730.2011.579688.
36.
SultanDHRiversBMOsongoBO. Affecting African American men’s prostate cancer screening decision making through a mobile tablet-mediated intervention. J Health Care Poor Underserved. 2014;25(3):1262–1277. doi:10.1353/hpu.2014.0148.
37.
LisettiCYasavurUde LeonCAminiRRisheNVisserU. Building an on-demand avatar-based health intervention for behavior change. Paper presented at: Proceedings of the 25th International FLAIRS Conference; May 23-25, 2012; Marco Island, FL.
38.
SchulmanDBickmoreTSidnerC. An intelligent conversational agent for promoting long-term health behavior change using motivational interviewing. Palo Alto, CA: AAAI Spring Symposium on AI and Health Communication; 2011.
39.
BakerSCWentzRKWoodsMM. Using virtual worlds in education: Second Life® as an educational tool. Teach Psychol. 2009;36(1):59–64.
40.
BeardLWilsonKMorraDKeelanJ. A survey of health-related activities on second life. J Med Internet Res. 2009;11(2):e17.
41.
WoodA. Using emerging technologies to enhance learning. Nurs Sci Q. 2010;23(2):173–179.
42.
van den BrekelAJP. Get Your Consumer Health Information From an Avatar!: Health and Medical Related Activities in a Virtual Environment. Krakow, Poland: European Association for Health Information & Libraries Workshop; 2008.
43.
KingACBickmoreTWCamperoMIPruittLAYinJL. Employing virtual advisors in preventive care for underserved communities: results from the COMPASS study. J Health Commun. 2013;18(2):1449–1464.
44.
BickmoreTWPfeiferLMPaasche-OrlowMK. Using computer agents to explain medical documents to patients with low health literacy. Patient Educ Couns. 2009;75(3):315–320.
45.
VenkateshVMorrisMGDavisGBDavisFD. User acceptance of information technology: toward a unified view. MIS Quart. 2003;27(3):425–478. doi:10.2307/30036540.
46.
MayerREMorenoR. Nine ways to reduce cognitive load in multimedia learning. Educ Psychol. 2003;38(1):43–52. doi:10.1207/S15326985EP3801_6.
47.
IsraelBASchulzAJParkerEABeckerABAllenAJIIIGuzmanJR. Critical issues in developing and following community based participatory research principles. In: MinklerM ed. Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass; 2003:53–79.
48.
IsraelBASchulzAJParkerEABeckerAB; Community-Campus Partnerships for Health. Community-based participatory research: policy recommendations for promoting a partnership approach in health research. Educ Health (Abingdon). 2001;14(2):182–197. doi:10.1080/13576280110051055.
49.
IsraelBASchulzAJParkerEABeckerAB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202. doi:10.1146/annurev.publhealth.19.1.173.
50.
BunzU. The computer-email-web (CEW) fluency scale—development and validation. Int J Hum Comput Interact. 2004;17(4):479–506.
51.
CormierLKwanLReidKLitwinMS. Knowledge and beliefs among brothers and sons of men with prostate cancer. Urology. 2002;59(6):895–900. doi:10.1016/S0090-4295(01)01657-0.
52.
CompeauDHigginsC. Computer self-efficacy: development of a measure and initial test. MIS Quart. 1995;19(2):189–211. doi:10.2307/249688.
53.
OwensOLJamesCFriedmanDB. Overcoming the challenges of African-American recruitment in health sciences research: strategies and recommendations. Urol Nurs. 2017;37(6):293–315.
54.
National Cancer Institute. What You Need to Know About Prostate Cancer. Bethesda, MD: National Cancer Institute; 2008.
55.
FriedmanDBCorwinSJDominickGMRoseID. African American men’s understanding and perceptions about prostate cancer: why multiple dimensions of health literacy are important in cancer communication. J Community Health. 2009;34(5):449–460. doi:10.1007/s10900-009-9167-3.
56.
FriedmanDBThomasTLOwensOLHébertJR. It takes two to talk about prostate cancer a qualitative assessment of African American men’s and women’s cancer communication practices and recommendations. Am J Mens Health. 2012;6:472–84doi:10.1177/1557988312453478.
57.
OwensOLFriedmanDBBrandtHMBernhardtJMHébertJR. Digital solutions for informed decision making: an academic–community partnership for the development of a prostate cancer decision aid for African American men. Am J Mens Health. 2016;10(3):207–19. doi:10.1177/1557988314564178.
58.
ChanECMcFallSLByrdTL. A community-based intervention to promote informed decision making for prostate cancer screening among Hispanic American men changed knowledge and role preferences: a cluster RCT. Patient Educ Couns. 2011;84(2):e44–e51. doi:10.1016/j.pec.2010.07.033.
59.
OwensOLFriedmanDBBrandtHMBernhardtJMHebertJR. An iterative process for developing and evaluating a computer-based prostate cancer decision aid for African American men. Health Promot Pract. 2015;16(5):642–655. doi:10.1177/1524839915585737.
60.
LoebSVellekoopAAhmedHU. Systematic review of complications of prostate biopsy. Eur Urol. 2013;64(6):876–892. doi:10.1016/j.eururo.2013.05.049.
61.
VolkRJSpannSJCassARHawleyST. Patient education for informed decision making about prostate cancer screening: a randomized controlled trial with 1-year follow-up. Ann Fam Med. 2003;1(1):22–28. doi:10.1370/afm.7.
62.
PeekMEOdoms-YoungAQuinnMTGorawara-BhatRWilsonSCChinMH. Race and shared decision making: perspectives of African-Americans with diabetes. Soc Sci Med. 2010;71(1):1–9. doi:10.1016/j.socscimed.2010.03.014.
63.
PeekMEWilsonSCGorawara-BhatROdoms-YoungAQuinnMTChinMH. Barriers and facilitators to shared decision making among African-Americans with diabetes. J Gen Intern Med. 2009;24(10):1135. doi:10.1007/s11606-009-1047-0.
64.
SmithRAManassaram-BaptisteDBrooksD. Cancer screening in the United States, 2014: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2014;64(1):30–51. doi:10.3322/caac.21212.
65.
RimerBKBrissPAZellerPKChanECWoolfSH. Informed decision making: what is its role in cancer screening?Cancer. 2004;101(suppl 5):1214–1228. doi:10.1002/cncr.20512.
66.
DySMPurnellTS. Key concepts relevant to quality of complex and shared decision making in health care: a literature review. Soc Sci Med. 2012;74(4):582–587. doi:10.1016/j.socscimed.2011.11.015.
DurandMACarpenterLDolanH. Do interventions designed to support shared decision making reduce health inequalities? A systematic review and meta-analysis. PLoS One. 2014;9(4):e94670. doi:10.1371/journal.pone.0094670.
69.
ZimmermanEWoolfSHaleyA. Understanding the Relationship Between Education and Health. Rockville, MD: Agency for Healthcare Research and Quality; 2015.
70.
TamboriniCRKimCSakamotoA. Education and lifetime earnings in the United States. Demography. 2015;52(4):1383–1407.
71.
SchroyPCMylvaganamSDavidsonP. Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expect. 2014;17(1):27–35. doi:10.1111/j.1369-7625.2011.00730.x.
72.
BlumenthalD. Launching HITECH. N Engl J Med. 2010;362(5):382–385. doi:10.1056/NEJMp0912825.
LenertLDunleaRDel FiolGHallLK. A model to support shared decision making in electronic health records systems. Med Decis Making. 2014;34(8):987–995. doi:10.1177/0272989X14550102.
