Telehealth and racial disparities in colorectal cancer screening: A pilot study of how virtual clinician characteristics influence screening intentions

Abstract

Introduction: Racial disparities in colorectal cancer (CRC) can be addressed through increased adherence to screening guidelines. In real-life encounters, patients may be more willing to follow screening recommendations delivered by a race concordant clinician. The growth of telehealth to deliver care provides an opportunity to explore whether these effects translate to a virtual setting. The primary purpose of this pilot study is to explore the relationships between virtual clinician (VC) characteristics and CRC screening intentions after engagement with a telehealth intervention leveraging technology to deliver tailored CRC prevention messaging. Methods: Using a posttest-only design with three factors (VC race-matching, VC gender, intervention type), participants (N = 2267) were randomised to one of eight intervention treatments. Participants self-reported perceptions and behavioral intentions. Results: The benefits of matching participants with a racially similar VC trended positive but did not reach statistical significance. Specifically, race-matching positively influenced screening intentions for Black participants but not for Whites (b = 0.29, p = 0.10). Importantly, perceptions of credibility, attractiveness, and message relevance significantly influenced screening intentions and the relationship with race-matching. Conclusions: To reduce racial CRC screening disparities, investments are needed to identify patient-focused interventions to address structural barriers to screening. This study suggests that telehealth interventions that match Black patients with a Black VC can enhance perceptions of credibility and message relevance, which may then improve screening intentions. Future research is needed to examine how to increase VC credibility and attractiveness, as well as message relevance without race-matching.

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

“…Also, the intersection of race and rural identity underscores the need to account for rural identity as part of efforts to address racial cancer health disparities. Appearance evaluations are critical in this digital context, given source attractiveness positively influences acceptance of cancer prevention messaging and colorectal cancer screening intentions ( Baylor, 2009 , Cooks et al, 2022 , Liao et al, 2019 , Patzer, 1983 , Valinatajbahnamiri and Siahtiri, 2021 ). Therefore, it is imperative that digital colorectal cancer screening interventions targeting rural disparities allocate resources to develop culturally appropriate VHCs that optimize appearance.…”

“…This study focuses on rural identity effects related to VHC race-matching. Statistical models did not consider VHC gender-matching and intervention type and have been reported elsewhere ( Cooks et al, 2022 , Krieger et al, 2021 ). 1…”

“…The static ALEX provides identical content in text and still photos. ALEX is a patient-centered intervention that addresses various screening modalities (e.g., colonoscopy, Cologuard, FIT) (For more information on the ALEX intervention, see Cooks et al, 2022 , Krieger et al, 2021 ).

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“…One way to enhance credibility in face-to-face encounters is racial concordance between patient and clinician ( Street et al, 2008 , Thornton et al, 2011 ) . In the telehealth context, VHC credibility has a positive influence on colorectal cancer screening intention ( Cooks et al, 2022 ). Matching patients with a race-concordant VHC can also positively influence screening intentions due to increased credibility ( Cooks et al, 2022 , Griffin et al, 2019 , Hung et al, 2020 , Krieger et al, 2021 , Shen et al, 2018 , ter Stal et al, 2020 ).…”

“…In the telehealth context, VHC credibility has a positive influence on colorectal cancer screening intention ( Cooks et al, 2022 ). Matching patients with a race-concordant VHC can also positively influence screening intentions due to increased credibility ( Cooks et al, 2022 , Griffin et al, 2019 , Hung et al, 2020 , Krieger et al, 2021 , Shen et al, 2018 , ter Stal et al, 2020 ). Intentions to screen are often positively associated with screening completion ( Brumbach et al, 2017 , Birmingham et al, 2015 ).…”