The development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Applications for and by Black Men: A Qualitative Study (Preprint)

BACKGROUND Traditionally, promotion of colorectal cancer (CRC) screening among Black men were delivered by Community Health Workers (CHW), Patient Navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one's home. OBJECTIVE The objective of this study was to incorporate the perceptions of Black men in the development of a Virtual Clinician (VC) designed to deliver precision messages promoting the Fecal Immunochemical Test (FIT) kit for CRC screening among Black men in a future clinical trial. METHODS Focus groups of Black men were recruited to understand their perceptions of a Black-male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The MAIN Model which examines how an interface features affect the user's psychology through four Affordances: Modality, Agency, Interactivity, and Navigability was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or negative perception of trustworthiness, believability, and understandability thereby increasing source credibility. RESULTS Twenty-five Black men were recruited from the community and contributed to the development of three iterations of a Black male VC over an eighteen-month time span. Feedback from the man enhanced the visual appearance of the VC including its movement, clothing, facial expressions, and environmental surroundings. Heuristics including social presence, novelty, and authority were all recognized by the final version of the VC and creditably was established. The VC was referred to as "brother-doctor" and participants stated "wanting to interact with ALEX over their regular doctor". CONCLUSIONS Involving Black men in the development of a digital healthcare intervention is critical. This population is burdened by cancer health disparities and incorporating their perceptions in tele-health interventions, will create awareness of the need to develop targeted messages for Black men. CLINICALTRIAL