Background
Numerous studies investigating the use of computerized behavioral interventions have been reported, and were summarized in a 2001 review1. These studies typically provide little information about the path taken to a particular design, although several have reported using qualitative2 or human factors3 approaches. Thus, little is known about the preferences of individuals at whom an intervention is targeted. This is understandable, given the difficulty in obtaining such information, particularly from those who may not be familiar with any patient educational or behavioral interventions, much less those that are computerized. We report on a qualitative study that was performed in preparation for designing a computerized behavioral intervention aimed at improving prostate cancer screening-related shared decision making between men and their physicians.
Methods
Thirteen semi-structured interviews were conducted with men from a large metropolitan university based health system with four African American and nine Caucasian men, aged 40 to 70. The interview questions focused on preferences for message content, medium, messengers, and location of the educational intervention. The interviews were audiotaped, transcribed, and in-vivo coding, wherein codes were identified within the transcript, rather than using a pre-existing coding scheme. Code frequencies are represented below in parentheses.
Results
Content
Men stated that the message delivered by the intervention should focus on knowledge (5) and prevention or lifestyle factors (3).
Delivery medium
Six of the 13 participants generally endorsed the use of an interactive (but not necessarily computerized) intervention. Of these six, three stated that they would prefer a computerized intervention, while the others stated that they would not. Two specific concerns about computerized interventions were voiced by the participants: loss of anonymity (1) and reliability or distrust of the information (2). Six men approved of the use of pamphlets or print media, favoring newspaper (3). Others suggested methods of instruction including television (2) and face-to-face seminars (3).
Format
The participants generally liked the idea of a tailored personalized intervention, citing voices (1), printouts (3), captioning (1), instant feedback (1), and questions-and-answer format (3) as desirable features. Several endorsed the use of specific question-and-answer (2) and risk/benefit analysis (1) sections in the intervention. More (8) preferred a non-game intervention than those (4) who endorsed the concept.
Messengers
When asked who should deliver the message about prostate cancer and screening, participants identified celebrities (5), prostate cancer survivors (3), physicians (2), nurses (2), “someone like me” (1), any knowledgeable person (3).
Location
The participants expressed difficulty in conceptualizing an intervention; this is reflected in the small number who expressed an opinion about possible placement locations. Those who were able to answer this question suggested placement in the home (5), the community (1), and physician offices (2), occupational health (1) and health fairs (1).
Future work
A large-scale survey, informed by the results of this qualitative study, will be conducted to quantify patient preferences which will be addressed in the final design of the intervention.
Acknowledgement
This study was sponsored by the Center for Population Health and Health Disparities at the University of Pennsylvania under Public Health Services Grant P50-CA105641.
REFERENCES
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