ASPO Abstracts
Impact of Prostate Cancer Screening on Colorectal Cancer Screening Behavior Intentions: Qualitative Results from Interacting with a Virtual Healthcare Assistant (VHA)
Category: Behavioral Science & Health Communication
Conference Year: 2020
Abstract Body:
Purpose of Study: Grounded in the Health Belief Model, our study’s objective was to enhance the development of
a demographically matched Virtual Healthcare Assistants (VHA) app promoting colorectal cancer (CRC) screening
using the Fecal Immunochemical Test (FIT) kit.
Methods: In a user-centered design approach, focus group members individually engaged with either a Black or
White male VHA app via a smartphone, discussed their experience, and provided recommendations. Seventeen
focus groups with 25 Black and 38 White men (n=63) between the ages of 50-73 were conducted from January
2017 to November 2018. Each group contributed iteratively to the final app. Identification of thematic categories
from transcripts and a coding manual was created by two team members. All data were analyzed using NVivo
software.
Results: Feedback of the VHA app was positive and behavioral intentions towards screening for CRC via the FIT,
increased in all the focus groups. One essential theme that emerged was perceived patient-level barriers to
screening. Common screening barriers identified in the study included: fear and lack of knowledge of different
screening methods, fear of positive results, and fear of comprising masculinity associated with anal penetration
screening methods (i.e. colonoscopy). An interesting barrier indirectly identified was the confusion between CRC
and prostate cancer. Confusion with PSA levels and fear associated with getting the “Finger” were frequently
stated as barriers to obtaining CRC screening in multiple focus groups with Black men. The “camera” test
(colonoscopy; CRC) was more accepted than the “finger” test (digital rectal exam; prostate cancer). In addition, a
fatalistic attitude to not participating in any screening that utilized anal penetration was observed. To resolve the
confusion and negative perceptions, the difference between prostate and CRC, their screening methods and
overall definition of cancer were continuously discussed.
Conclusion: Results from this study highlight a need for tailored messaging interventions addressing gender
specific barriers. Tools targeting men, like the VHA app, need to be developed to increase knowledge of cancer,
cancer screening methods and eliminate screening barriers associated with comprising masculinity.
Keywords: Colon Cancer, Prostate Cancer, Black Men, mobile- Health, Screening barriers