A Subjective Culture Approach to Cancer Prevention: Rural Black and White Adults’ Perceptions of Using Virtual Health Assistants to Promote Colorectal Cancer Screening

Abstract

In the US, Black adults are less likely than White adults to be screened for colorectal cancer (CRC). This study uses a subjective culture approach to describe and compare perceptions of a CRC screening intervention delivered via virtual health assistants (VHAs) among rural Black and White study participants. We analyzed 28 focus groups with Black (n = 85) and White (n = 69) adults aged 50-73. Participants, largely recruited through community engagement efforts, tested the VHA intervention on mobile phones provided by the research team. Moderated discussions were recorded, transcribed, and analyzed using thematic analysis. All groups preferred the VHA to be friendly. Other important cues included trustworthiness, authority, and expertise. Black participants expressed a preference for receiving information about their CRC risk from the VHA compared with White adults. Black participants also expressed the importance of sharing the intervention and the CRC screening messages with younger members of their networks, including family members who could benefit from screening messages before reaching the recommended age for screening. The key similarities and differences between Black and White adults' perceptions of the intervention that were identified in this study can help inform future efforts to develop effective communication strategies and reduce cancer screening inequities.

The Impact of Pedagogical Agents' Gender on Academic Learning: A Systematic Review

“…The advantages of adapting virtual agents to participants have been demonstrated in several studies. For instance, in Vilaro et al ( 2021 ), participants (all Black women) liked Black female agents for being artificial, hence creating a sense of trust and freedom where participants could avoid inherent biases and racism. In virtual learning environments, research has shown the impact of virtual agents' gender on human-agent interactions (refer to Section 3.4).…”

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

“…Regardless of the VHC they interacted with, individuals with a higher rural identity had more positive impressions of appearance. Prior work suggests rural adults prefer VHCs seen as calm and with a smiling and inviting face ( Vilaro et al, 2021a ). The current study suggests adults with high rural identity may be even more attuned to VHC appearance, possibly due to sociocultural norms for rurality that value virtual agents being similar to community members as a credibility indicator ( Mendu et al, 2018 ).…”

“…It can be reasoned that shared negative experiences with rural healthcare systems (e.g., structural racism, discrimination) foster a strong sense of rural belonging among Black adults ( Fowler-Brown et al, 2006 , Hammonds and Reverby, 2019 ). More specifically, rural Black adults may attend more closely to VHC features such as clothing and perceived professionalism ( Vilaro et al, 2021a ). This differential effect based on race may be explained by the fact that identifying as both Black and rural represents two stigmatized identities, creating a novel intervention response.…”

“…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.…”

A Framework for Equitable Partnerships to Promote Cancer Prevention and Control in Rural Settings

“…In some rural communities, cultural factors may be manifested more subjectively and interrelated with race ( 25 , 26 ). Research conducted among rural Black and White adults from North Florida showed that cultural factors manifested into preferences on how patients wanted to be engaged with the health-care system, and these preferences were also intertwined with race ( 27 ).…”