Abstract ED01-03: The acceptability and usability of an mHealth intervention to address prostate cancer disparities: A community-based participatory approach
Authors: Rivers Brian M. , Osongo Ben , Carvajal Rodrigo , Tillman Emerson , Schenck April , Roetzheim Richard , Green B. Lee 
Published: May 2015

Abstract
Recent advances in mobile technologies have transformed the way we communicate and obtain information. Mobile technologies include mobile phones, smartphones, and tablet PCs. These devices have a range of functions from mobile cellular communication via telephone or text messages (SMS); ability to transmit photos and video; access to the internet; and software applications or ‘apps’. These technological advancements present a tremendous opportunity to impact cancer health disparities, which are differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States (U.S.) (NCI, 2013). A commonly known cancer health disparity is the disproportionate impact of prostate cancer on African American (AA) men in the U.S. Whereas African Americans have the highest death rate and shortest survival of any racial and ethnic group in the U.S. for most cancers (ACS, 2013), this remains true in the context of prostate cancer. African American men have a 60% higher incidence rate and the death rate is 2.4 times higher than in white men (ACS, 2013). The causes of these inequalities are complex and are thought to reflect an unique interplay of biological differences and social and economic disparities. These social and economic disparities or social determinants of health include inequities in work, wealth, income, education, housing, and overall standard of living which often serve as barriers to high-quality cancer prevention, early detection, and treatment services These inequities are commonly paralleled by differences in access, use, and processing of cancer information or communication inequalities (Viswanath, 2006).
Communication inequalities, a key predictor of health and healthcare disparities, has been defined as differences among social groups in the generation, manipulation, and distribution of information at the group level and differences in access to and ability to take advantage of information at the individual level (Viswanath, 2006). Communication inequalities have been documented along 5 broad dimensions: a) access to and use of communication technologies and media, b) attention to health information, c) active seeking of information, d) information processing, and e) communication effects on health outcomes. It has been hypothesized that inequalities in communication mediate the relationship between social determinants and outcomes along the cancer continuum, and thus serves as one explanation for cancer and other health disparities (Viswanath, 2006).
As noted by the Institute of Medicine (IOM), to maximize the potential benefits of new communication technologies, “in many cases, new technology should be combined with established communication strategies,” (IOM, 2002). One established communication strategy among minority and medically underserved populations is the Community Health Worker (CHW) model. Historically, CHWs have been deemed an effective strategy traced back to the 1960's when it was created through the support of the federal government (Witmer, 1995) with the goal of reaching people in underserved communities and presenting health and screening information (Swider, 2002). The philosophy of CHW is to train selected community members in specific health topics so that they may then serve as an educational resource to other community members in making the appropriate health decisions. A common limitation to this community-based participatory strategy is the lack of evaluation of assessing the accuracy and comprehensiveness of the information and education provided. Utilization of mHealth interventions, such as apps delivered via mobile tablet technology provides, the ability to standardize the message delivered by CHW and received by community members. However, it remains unknown if African American men are receptive to utilizing mobile tablet technology to receive health education and health promotion messaging and secondarily if they would be amendable to messaging via an app. Given the increasing constraints of the patient/provider information exchange and the lack of conclusive evidence across the continuum of care for prostate cancer, in this study we sought to 1) examine the receptivity of African American men to receiving prostate cancer control messages via mobile tablet technology delivered by CHWs (Phase I) and 2) determine if African Americans would actually use an app to seek health information (Phase II). The findings presented in this paper are from two distinct phases of a larger community-based trial. In both phases, a convenience sampling strategy was administered for recruitment. Trained CHWs recruited African Americans from select community-based settings.
In Phase I, data were obtained from 152 African American male respondents who were enabled by the CHWs to directly interface with the mobile tablet technology. Demographic data and responses to a 26-item participant acceptability survey were collected form participants. The collected information yielded measures of respondents' characteristic variables (i.e., educational level, income, marital status, and age) and their acceptability of the iPad delivered by a CHW. These findings will be presented in this session.
The Usability Testing methodology, field testing, was implemented during Phase II. Data were obtained from 53 African American men and women who were enabled by CHWs to interface with the mobile tablet technology. Demographic and survey responses were obtained from participants. The survey used to gather this information from participants was divided into two sections. The first section had eleven (11) items that prompted a participant to rate their experience or position regarding the ease of use of the application via mobile tablet technology. The second section consisted of twenty three (23) items that required a participant to also rate their experience or position about specific ease of use with content and graphical display of the application. The response options were on a 5-point likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). These findings will also be presented in this session.
Citation Format: Brian M. Rivers, Ben Osongo, Rodrigo Carvajal, Emerson Tillman, April Schenck, Richard Roetzheim, B. Lee Green. The acceptability and usability of an mHealth intervention to address prostate cancer disparities: A community-based participatory approach. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr ED01-03. doi:10.1158/1538-7755.DISP13-ED01-03