Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study

Abstract

Background Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, 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 modality, agency, interactivity, and navigability (MAIN) model, which examines how 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 a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men 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 named Agent Leveraging Empathy for eXams (ALEX) and 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 health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men.

Artificial intelligence technologies and compassion in healthcare: A systematic scoping review

“…Race-concordance has emerged as an important factor in the design and use of virtual patients and virtual clinicians, but the implications for teaching and practice are unclear and underexplored ( Halan et al, 2015 ; Krieger et al, 2021 ). For example, in one design study black men ( n = 25) designed a Black male virtual clinician (VC) that was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor”; participants wanted to interact with ALEX over their regular doctor ( Wilson-Howard et al, 2021 ). While automated services could extend access to psychological support, research into digital therapeutic alliance is needed to ensure AI technologies work for diverse patient groups ( Scholten et al, 2017 ; Grekin et al, 2019 ; Tong et al, 2022 ).…”

Can virtual human clinicians help close the gap in colorectal cancer screening for rural adults in the United States? The influence of rural identity on perceptions of virtual human clinicians

“…In Phase 2, users tested the prototype and commented on character details that informed refinement (e.g., added white coat, changed lighting, removed gray hair). Phase 3 included additional feedback on VHC appearance (e.g., added smile, focused eye gaze, changed hairstyle), leading to final modification (see Vilaro et al, 2020 , Wilson-Howard et al, 2021 ). Efforts were made to reduce the health literacy for engagement (i.e., visuals of stool sample collection rather than words).…”

“…One key dimension of credibility is attractiveness; message sources rated as more attractive are often more persuasive and generate increased behavioral motivation (Baylor et al, 2009; Cialdini, 2001 , Cialdini and Goldstein, 2004 , Chaiken, 1979 , Ohanian, 1990 , Wilson-Howard et al, 2021 ). The flexibility of VHCs allows for systematic enhancements to appearance.…”

“…The flexibility of VHCs allows for systematic enhancements to appearance. Recent findings in developing culturally appropriate VHCs for rural Black adults suggest credibility is influenced by technical quality and appearance ( Vilaro et al, 2021a , Wilson-Howard et al, 2021 ). Simply put, VHC appearance is an indicator of credibility, particularly among rural adults, which influences colorectal cancer screening intentions.…”

“…The importance of VHC appearance for credibility and acceptability among rural adults was also a consistent theme during user-centered ALEX development. One tester commented, “Like I say, being as that he was a brother-doctor look, it was more acceptable to listen to it opposed to another type,” while another mentioned, “I don’t want to go to nobody looking all weird and start asking me questions” ( Vilaro et al, 2021b , Wilson-Howard et al, 2021 ). Given the importance of VHC appearance, the purpose of this pilot was to explore how to develop VHCs that rural adults would find attractive.…”