Breast Self-Examination System Using Multifaceted Trustworthiness: Observational Study
Authors: Khana Rajes , Mahinderjit Singh Manmeet , Damanhoori Faten , Mustaffa Norlia 
Published: August 2020

Background
Breast cancer is the leading cause of mortality among women worldwide. However, female patients often feel reluctant and embarrassed about meeting physicians in person to discuss their intimate body parts, and prefer to use social media for such interactions. Indeed, the number of patients and physicians interacting and seeking information related to breast cancer on social media has been growing. However, a physician may behave inappropriately on social media by sharing a patient’s personal medical data excessively with colleagues or the public. Such an act would reduce the physician’s trustworthiness from the patient’s perspective. The multifaceted trust model is currently most commonly used for investigating social media interactions, which facilitates its enhanced adoption in the context of breast self-examination. The characteristics of the multifaceted trust model go beyond being personalized, context-dependent, and transitive. This model is more user-centric, which allows any user to evaluate the interaction process. Thus, in this study, we explored and evaluated use of the multifaceted trust model for breast self-examination as a more suitable trust model for patient-physician social media interactions in breast cancer screening.

Objective
The objectives of this study were: (1) to identify the trustworthiness indicators that are suitable for a breast self-examination system, (2) design and propose a breast self-examination system, and (3) evaluate the multifaceted trustworthiness interaction between patients and physicians.

Methods
We used a qualitative study design based on open-ended interviews with 32 participants (16 outpatients and 16 physicians). The interview started with an introduction to the research objective and an explanation of the steps on how to use the proposed breast self-examination system. The breast self-examination system was then evaluated by asking the patient to rate their trustworthiness with the physician after the consultation. The evaluation was also based on monitoring the activity in the chat room (interactions between physicians and patients) during daily meetings, weekly meetings, and the articles posted by the physician in the forum.

Results
Based on the interview sessions with 16 physicians and 16 patients on using the breast self-examination system, honesty had a strong positive correlation (r=0.91) with trustworthiness, followed by credibility (r=0.85), confidence (r=0.79), and faith (r=0.79). In addition, belief (r=0.75), competency (r=0.73), and reliability (r=0.73) were strongly correlated with trustworthiness, with the lowest correlation found for reputation (r=0.72). The correlation among trustworthiness indicators was significant (P<.001). Moreover, the trust level of a patient for a particular physician was found to increase after several interactions.

Conclusions
Multifaceted trustworthiness has a significant impact on a breast self-examination system. Evaluation of trustworthiness indicators helps to ensure a trustworthy system and ethical interaction between a patient and physician. A new patient can obtain a consultation by referring to the best physician according to preference of other patients. Patients can also trust a physician based on another patient’s recommendation regarding the physician’s trust level. The correlation analysis further showed that the most preferred trustworthiness indicator is honesty.