Feasibility of Virtual Agent Cervical Cancer Education for Hispanic Farmworkers

描述（由申请人提供）：与美国普通人群相比，拉丁美洲人的宫颈癌（CC）发病率和死亡率更高。许多拉丁裔人无法获得医疗保健，并经历了扫盲、沟通和知识方面的障碍，使他们无法获得CC筛查。实施了患者导航员（PN）和其他类似的干预措施，以提高CC筛查率；然而，很少有人直接关注拉丁裔的需求。交互式技术干预，如具体化会话代理（ECA），目前在其他人群、环境和其他健康主题中使用，但没有已知的倡议使用文化和扫盲适当的技术来提供西班牙语CC教育，作为PN干预的一部分。本研究旨在创建并对西班牙语虚拟患者教育者（VPE）多媒体应用程序进行初步评估，以增加农村农业社区拉丁裔患者CC筛查率的PN干预。利用社会认知理论，建议项目将分两个阶段进行。在第一阶段，研究小组将与社区成员合作开发一个由ECA组成的低识字率西班牙语交互式多媒体应用程序。项目团队将利用理论原理和形成性研究成果，通过系统和技术流程设计VPE。将执行目标受众成员的持续反馈（可用性测试），以确保患者（用户）能够高效、有效和令人满意地执行预期的系统任务。一旦可用性测试完成，将进行一系列学习者验证访谈，以评估VPE的初始适用性。由于VPE将是已知的第一个用于增强PN干预的西班牙语ECA，因此重要的是要了解患者是否接受VPE，以及通过VPE增强患者导航的研究是否可行。在第二阶段，将对60名未根据美国妇产科医师学会指南进行推荐的CC筛查的患者进行两种导航分娩方法（有和没有VPE）的初步评估。将使用聚类随机化将患者随机分配到2种PN干预条件中的1种：(1)PN；或(2)PN+VPE (PN+VPE)，以临床日期为随机化单位。初步评估将审查招募、随机化、数据收集、

DESCRIPTION (provided by applicant): Latinas experience higher cervical cancer (CC) incidence and mortality when compared to the general population in the United States. Many Latinas lack access to health care and experience literacy, communication, and knowledge barriers that prevent them from obtaining CC screening. Patient navigator (PN) and other similar interventions have been implemented to increase CC screening rates; however, few have focused directly on the needs of Latinas. Interactive technological interventions, like embodied conversational agents (ECA), are currently used in other populations, settings, and for other health topics, but no known initiative has used culturally and literacy appropriate technology to deliver Spanish-language CC education as part of a PN intervention. This study aims to create and conduct a preliminary evaluation of a Spanish-language Virtual Patient Educator (VPE) multimedia application to augment a PN intervention for increasing CC screening rates among Latinas in a rural agricultural community. Using the Social Cognitive Theory, the proposed project will be conducted in 2 phases. In Phase 1, the research team will engage community members to develop a low literacy Spanish-language interactive multimedia application consisting of an ECA. Using theoretical principles and drawing from our formative research, the project team will design the VPE through systematic and technical processes. Ongoing feedback (usability testing) from members of the intended audience will be carried out to ensure that patients (users) can perform intended system tasks efficiently, effectively, and satisfactoril. Once usability testing is complete, a series of learner verification interviews will be conducted t assess initial suitability of the VPE. Since the VPE will be the first known Spanish-language ECA used to augment a PN intervention, it is important to see whether patients accept the VPE and whether it is feasible to conduct a study of patient navigation augmented by the VPE. In Phase 2, a preliminary evaluation of 2 methods of patient navigation delivery (with and without VPE) will be conducted with 60 participants who are not up to date with recommended CC screening according to American College of Gynecologists and Obstetricians' guidelines. Cluster randomization will be used to randomize patients to 1 of 2 PN intervention conditions: (1) PN; or (2) PN plus VPE (PN+VPE) using date of clinic as unit of randomization. The preliminary evaluation will examine the feasibility of recruitment, randomization, data collection, and acceptability of VPE application. Exploratory data will also be collected regarding the potential impact of PN+VPE on behavioral capacity and self-efficacy for obtaining CC screening, Pap test adherence, and satisfaction with care. The proposed project will advance our research towards the development of interactive technology interventions to disseminate health education to disparate populations. PUBLIC HEALTH RELEVANCE: Latinas experience higher cervical cancer incidence and mortality when compared to the general population in the United States. The proposed study is the first to develop interactive technology to augment a patient navigation intervention by providing patient education about human papillomavirus, cervical cancer, and the importance of regular cervical cancer screening. A patient navigation intervention augmented by interactive educational technology is expected to enhance and extend access to health information and health care for Spanish-speaking Latinas living in a rural agricultural community.