Table 2.

Strategies used to develop, evaluate cancer-related PtDAs for disadvantaged social groups (k = 20)

Study	Eligibility criteria	Conceptual framework (if specified)	PtDA Format	Delivery Mode, setting	Sub-groups targeted in Dev.	Development (k = 17)	Evaluation (k = 14)
BCa, Genetic Testing
Lerman 1997 [40]	Women 18-75y, ≥1 1st-degree relative with BCa and/or ovarian cancer	Behavioral decision-making models	Structured education (45-60 min) + semi-structured counseling (15-30 min)	By nurse or genetic counselor at oncology clinic	BLK	NR	Included PtDA-by- race interaction (no difference)
BCa, Treatment
Jibaja-Weiss 2010 [50]	Women, early stage BCa	ODSF, EDAM	Interactive DVD/CD soap opera episodes, learning modules (43-207 min) [108]	By patient at clinic (with case manager assistance)	LOW-LIT, UNINS, BLK, HSP, SPN	Content developed by research team, expert advisory panel; usability, acceptability, demand tests conducted in subgroups [108]; adapted to SPN language [108]	A priori focus on multi-ethnic, low literacy women; use of low-literacy DCS
Marcus 2013 [51]	Women, early stage BCa	Social cognitive, self-regulation theories, Health Belief Model	Interactive, multimedia web-based program or CD (>60 min) + NCI print materials	By patient at home via computer or Internet	LOW-LIT	Content guided by formative research with patients and developed by NCI, literacy, patient education experts with 7th grade readability target; usability, acceptability, demand tests conducted; reviewed for cultural appropriateness [51]; features of development sample NR	NR
Street 1995 [52]	Women, stage I/II BCa	NR	Interactive, multimedia program (30-45 min) vs. brochure (8 pages)	By patient at oncology clinic	LOW-ED	NR	Stratified/analyzed patients by age-education level (found older-less educated patients were less engaged)
CRC, Screening
Miller 2011 [56]	50–74y, due for CRCS	Transtheoretical model	Interactive web-based program (~10.1 min)	By patient at primary care clinic	LOW-LIT, BLK	Content based on educational video [57] that was guided by subgroup interviews;[109, 110] navigation designed for “low-literacy” subgroup	Stratified/analyzed patients by literacy level (no difference); used REALM tool
Pignone 2000 [57]	50–75y, due for CRCS	Transtheoretical model	Educational video (11 min)	By patient at primary care clinic	LOW-ED, FEM, BLK	Content guided by subgroup interviews; assessed out-of-pocket cost concerns	NR
Ruffin 2007 [58]	50–70y, due for CRCS	Elaboration likelihood model	Interactive web-based education tool	By patient in community setting via Internet	FEM, BLK	Content and usability testing guided by subgroup FGs and interviews; race-, gender- and insurance-related issues, potential differences were explored [111].	A priori focus on blacks
Schroy 2011, 2012 [59, 60]	50–75y, due for CRCS	ODSF	Interactive DVD + personal risk assessment tool (20-30 min)	By patient at primary care clinic	LOW-ED, FEM, MCAID, BLK	Content guided by expert opinion, subgroup FGs and assessed out-of-pocket cost concerns, cultural sensitivity issues; usability tests conducted in subgroups	A priori focus on blacks and low-income non-Hispanic whites
PCa Screening
Chan 2011 [63]	Men ≥40y, no PCa history	ODSF	Script, slides + video clips of role models (90-120 min), short booklets	By promotores to community center groups	LOW-ED, UNINS, MCAID, NONUS, HSP, SPN	Content guided by key informants, FGs; concept mapping conducted with men/spouses; adapted to SPN language	A priori focus on Hispanic and immigrant men
Lepore 2012 [67]	Men 45-70y, no PCa history	ODSF, social learning theory	Pamphlet + counseling sessions (~26.3 min)	By patient at home + health-educator via phone	LOW-ED, BLK	Content guided by expert opinion; feedback from men in target subgroups (including picture selection); cognitive interviews [112]	A priori focus on black and immigrant men; used low-literacy DCS
Myers 2005 [68]	Men 40-69y, no PCa or BPH history	PHM, AHP	Booklet + decision counseling session	By patient at home + health-educator via phone	LOW-ED, BLK	Content field-tested by literacy expert in face-to-face interviews with subgroup [113]; decision counseling protocol pilot tested in primary care practices in target community [113]	A priori focus on black men
Myers 2011 [69]	Men 50-69y, no PCa or BPH history	PHM, AHP	Booklet + decision counseling session	By patient at home + health-educator at primary care clinic	Refer to Myers 2005 [68]	Refer to Myers 2005 [68]	NR
Sheridan 2012 [73]	Men 40-80y, no PCa history	NR	Video (12 min) + coaching session (8 min)	By patient at primary care clinic (with research assistance)	NONWHT	Content pre-tested in FGs, cognitive interviews, usability tests in subgroups	NR
Taylor 2013 [74]	Men 45-70y, no PCa history	NR	Interactive web-based tool + booklet (~34 min)	By patients at home	LOW-LIT, BLK	Content guided by expert opinion, key informants, subgroup FGs [114, 115]; adapted to 8th grade readability by plain language expert; usability, acceptability, demand tests conducted in subgroups with limited computer/internet skills [114, 116]	NR
Volk 2003 [76]	Men 45-70y, no PCa history	NR	Videotape (~20 min) + brochure	By patient at PC clinic	NR	NR	Stratified analysis by race (found difference in screening rates)
Volk 2008 [77]	Men 40-70y, no PCa history	ODSF, EDAM	Interactive DVD/CD-based soap opera episodes, learning modules (53-68 min)	By patient at public hospital clinic (with research assistance)	LOW-LIT, UNINS, BLK	Content tailored using racial/ethnic concordance, social matching; acceptability tests conducted in subgroups	Stratified analysis by literacy; a priori interest in low-literacy black men (found differences in acceptability, decisional conflict); used low-literacy DCS
Williams 2013 [78]	Men 40-70y, no PCa history	NR	Booklet	By patient at home vs. patient at cancer screening clinic	LOW-LIT, BLK	Content by expert opinion, key informants, subgroup FGs [114, 115]; adapted to 8th grade readability by plain language expert; usability tests conducted in subgroups [114]	Stratified sub-analyses by race, including race-by delivery mode interaction (no differences)
Wolf 1996 [79]	Men ≥50y, no PSA testing or PCa history	NR	Script about PSA screening	By research assistant at PC clinic	LOW-ED, NONWHT	Content developed by physician experts; piloted via subgroup interviews; assessed for comprehensibility	Stratified sub-analyses by income, education (no difference)
PCa Treatment
Berry 2013 [81–83]	Men, localized PCa	ODSF	Interactive web-based program (~46 min) + usual patient education	Patient at home or oncology clinic	BLK	Content tailored by race via subgroup FGs, interviews [117, 118]; feasibility, acceptability tests conducted	Efficacy evaluation discussed decisional conflict by race (found differences in decisional conflict, perceived decision support)
Marcus 2013 [51]	Men, newly diagnosed localized PCa	Social cognitive, self-regulation theories, Health Belief Model	Interactive, multimedia web-based or CD program (>60 min) + NCI print materials	By patient at home via computer/internet	LOW-LIT, BLK	Content guided by formative research with patients and developed by NCI, literacy/patient education experts with 7th grade readability target; usability, acceptability, demand tests conducted; reviewed for cultural appropriateness [51]; features of development sample NR [119]	NR

DM decision-making, BCa breast cancer, ODSF Ottawa Decision Support Framework, EDAM edutainment decision aid model, IDM informed decision-making, LIT low literacy, UNINS uninsured, BLK black, HSP Hispanic, SPN Spanish language, DCS decisional conflict scale, SDM shared decision-making, NCI National Cancer Institute, NR not reported, CRCS colorectal cancer screening, REALM Rapid Estimate of Adult Literacy in Medicine, FEM female, FGs focus groups, MCAID Medicaid, PCa prostate cancer, NONUS non US-born, PSA prostate-specific antigen, NONWHT non-white