Date of Award


Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Daniela B Friedman


Background: African American (AA) men are significantly more likely to die of prostate cancer (PrCA) than other racial groups. Therefore, it is critical to identify effective strategies for providing information about the risks, benefits, and uncertainties of PrCA screening and the importance of informed decision making (IDM). To assess whether a computer-based IDM decision aid (DA) for PrCA screening would be appropriate for middle-age and older AA men, this formative evaluation study examined participants (1) PrCA risk and screening knowledge, 2) decision-making processes for PrCA screening, and 3) usage of, attitudes toward, and access to interactive communication technologies (ICTs). The usability and acceptability of the DA also was assessed. Methods: Thirty-nine AA men, ages 37-66 in South Carolina, were recruited through faith-based organizations to participate in one of six 90-minute focus groups (FGs) (Phase I) and to complete a 45-item demographic and health information seeking survey. Twenty-one of these 39 men volunteered to participate in one of seven additional FGs to provide feedback on a storyboard, script, and demonstration of a DA. They were also asked to complete a 35-item computer fluency and self-efficacy survey (Phase II). A full prototype of the DA was developed by the research team based on information gathered through Phases I and II FGs. A heuristic evaluation survey and prototype of the DA was sent to seven expert reviewers. Ten of 21 participants involved in Phase II FGs were randomly selected to participate in a 30- to 60-minute in-depth interview to assess the usability of the DA. Results: Participants were knowledgeable about PrCA; however, few engaged in IDM with their doctor and few were informed about the associated risks and uncertainties of PrCA screening. Most participants used ICTs on a daily basis for various purposes, including health information seeking. They were also open to using a novel computer-based DA for PrCA IDM if the system was easy to use and characters (e.g., avatars) were culturally appropriate. With regard to the usability, both participants and expert reviewers were accepting of most aspects of the DA, but suggested minor changes to improve effectiveness (e.g., improve avatar aesthetics). Conclusions: Because AA men have low exposure to IDM for PrCA, but frequently use ICTs for multiple purposes including health information seeking, digital DAs may be appropriate for this population. These DAs should not only aim to increase PrCA screening knowledge (especially regarding the risks and uncertainties of screening), but also stress the importance of IDM and prepare the user to engage in IDM with a doctor. It is also important to engage the community and expert reviewers in a formative, multi-stage development process to ensure that the resulting DA is optimal for use in the specific community. Future research should explore the effectiveness of the DA on AA women. The impact of the DA should also examine the impact of the DA when expanded to other channels (e.g., mobile phones).


© 2014, Otis LaShaun Owens

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