@article{cooks_duke_flood-grady_vilaro_ghosh_parker_te_george_lok_williams_et al._2022, title={Can virtual human clinicians help close the gap in colorectal cancer screening for rural adults in the United States? The influence of rural identity on perceptions of virtual human clinicians}, volume={30}, ISSN={["2211-3355"]}, DOI={10.1016/j.pmedr.2022.102034}, abstractNote={Rural adults experience disparities in colorectal cancer screening, a trend even more distinct among rural Black adults. Healthcare disruptions caused by COVID-19 exacerbated inequities, heightening attention on virtual communication strategies to increase screening. Yet little is known about how rural adults perceive virtual human clinicians (VHCs). Given that identifying as rural influences perceived source credibility often through appearance judgments, the goal of this pilot was to explore how to develop VHCs that individuals highly identified with rurality find attractive. Between November 2018 and April 2019, we tested a culturally tailored, VHC-led telehealth intervention delivering evidence-based colorectal cancer prevention education with White and Black adults (N = 2079) in the United States recruited through an online panel who were non-adherent to screening guidelines and between 50 and 73 years of age. Participants were randomized on three factors (VHC race-matching, VHC gender-matching, Intervention type). Ordinal logistic regression models examined VHC appearance ratings. Participants with a high rural identity (AOR = 1.12, CI = [1.02, 1.23], p =.02) rated the VHCs more attractive. High rural belonging influenced VHC attractiveness for Black participants (AOR = 1.22, CI = [1.03, 1.44], p =.02). Also, Black participants interacting with a Black VHC and reporting high rural self-concept rated the VHC as more attractive (AOR = 2.22, CI = [1.27, 3.91], p =.01). Findings suggest adults for whom rural identity is important have more positive impressions of VHC attractiveness. For patients with strong rural identities, enhancing VHC appearance is critical to tailoring colorectal cancer prevention interventions.}, journal={PREVENTIVE MEDICINE REPORTS}, author={Cooks, Eric J. and Duke, Kyle A. and Flood-Grady, Elizabeth and Vilaro, Melissa J. and Ghosh, Rashi and Parker, Naomi and Te, Palani and George, Thomas J. and Lok, Benjamin C. and Williams, Maribeth and et al.}, year={2022}, month={Dec} }
 @article{neil_parker_strekalova_duke_george_krieger_2022, title={Communicating risk to promote colorectal cancer screening: a multi-method study to test tailored versus targeted message strategies}, ISSN={["1465-3648"]}, DOI={10.1093/her/cyac002}, abstractNote={Colorectal cancer (CRC) screening rates are suboptimal, partly due to poor communication about CRC risk. More effective methods are needed to educate patients, but little research has examined best practices for communicating CRC risk. This multi-method study tests whether tailoring CRC risk information increases screening intentions. Participants (N = 738) were randomized with a 2:2:1 allocation to tailored, targeted, and control message conditions. The primary outcome was intention to screen for CRC (yes/no). Additional variables include perceived message relevance, perceived susceptibility to CRC, and free-text comments evaluating the intervention. A chi-square test determined differences in the proportion of participants who intended to complete CRC screening by condition. A logistic-based path analysis explored mediation. Free-text comments were analyzed using advanced topic modeling analysis. CRC screening intentions were highest in the tailored intervention and significantly greater than control (P = 0.006). The tailored message condition significantly increased message relevance compared with control (P = 0.027) and targeted conditions (P = 0.002). The tailored condition also increased susceptibility (P < 0.001) compared with control, which mediated the relationship between the tailored condition and intention to screen (b = 0.04, SE = 0.02, 95% confidence interval = 0.02, 0.09). The qualitative data reflect similar trends. The theoretical mechanisms and practical implications of tailoring health education materials about CRC risk are discussed.}, journal={HEALTH EDUCATION RESEARCH}, author={Neil, Jordan M. and Parker, Naomi D. and Strekalova, Yulia A. Levites and Duke, Kyle and George, Thomas and Krieger, Janice L.}, year={2022}, month={Mar} }
 @article{seifu_mt-isa_duke_gamalo-siebers_wang_dong_kolassa_2022, title={Design of paediatric trials with benefit-risk endpoints using a composite score of adverse events of interest (AEI) and win-statistics}, ISSN={["1520-5711"]}, DOI={10.1080/10543406.2022.2153202}, abstractNote={A fundamental problem in the regulatory evaluation of a therapy is assessing whether the benefit outweighs the associated risks. This work proposes designing a trial that assesses a composite endpoint consisting of benefit and risk, hence, making the core of the design of the study, to assess benefit and risk. The proposed benefit risk measure consists of efficacy measure(s) and a risk measure that is based on a composite score obtained from pre-defined adverse events of interest (AEI). This composite score incorporates full aspects of adverse events of interest (i.e. the incidence, severity, and duration of the events). We call this newly proposed score the AEI composite score. After specifying the priorities between the components of the composite endpoint, a win-statistic (i.e. win ratio, win odds, or net benefit) is used to assess the difference between treatments in this composite endpoint. The power and sample size requirements of such a trial design are explored via simulation. Finally, using Dupixent published adult study results, we show how we can design a paediatric trial where the primary outcome is a composite of prioritized outcomes consisting of efficacy endpoints and the AEI composite score endpoint. The resulting trial design can potentially substantially reduce sample size compared to a trial designed to assess the co-primary efficacy endpoints, therefore it may address the challenge of slow enrollment and patient availability for paediatric studies.}, journal={JOURNAL OF BIOPHARMACEUTICAL STATISTICS}, author={Seifu, Yodit and Mt-Isa, Shahrul and Duke, Kyle and Gamalo-Siebers, Margaret and Wang, William and Dong, Gaohong and Kolassa, John}, year={2022}, month={Dec} }
 @article{cooks_duke_neil_vilaro_wilson-howard_modave_george_odedina_lok_carek_et al._2022, title={Telehealth and racial disparities in colorectal cancer screening: A pilot study of how virtual clinician characteristics influence screening intentions}, volume={6}, ISSN={["2059-8661"]}, DOI={10.1017/cts.2022.386}, abstractNote={Abstract Introduction: Racial disparities in colorectal cancer (CRC) can be addressed through increased adherence to screening guidelines. In real-life encounters, patients may be more willing to follow screening recommendations delivered by a race concordant clinician. The growth of telehealth to deliver care provides an opportunity to explore whether these effects translate to a virtual setting. The primary purpose of this pilot study is to explore the relationships between virtual clinician (VC) characteristics and CRC screening intentions after engagement with a telehealth intervention leveraging technology to deliver tailored CRC prevention messaging. Methods: Using a posttest-only design with three factors (VC race-matching, VC gender, intervention type), participants ( N = 2267) were randomised to one of eight intervention treatments. Participants self-reported perceptions and behavioral intentions. Results: The benefits of matching participants with a racially similar VC trended positive but did not reach statistical significance. Specifically, race-matching positively influenced screening intentions for Black participants but not for Whites ( b = 0.29, p = 0.10). Importantly, perceptions of credibility, attractiveness, and message relevance significantly influenced screening intentions and the relationship with race-matching. Conclusions: To reduce racial CRC screening disparities, investments are needed to identify patient-focused interventions to address structural barriers to screening. This study suggests that telehealth interventions that match Black patients with a Black VC can enhance perceptions of credibility and message relevance, which may then improve screening intentions. Future research is needed to examine how to increase VC credibility and attractiveness, as well as message relevance without race-matching.}, number={1}, journal={JOURNAL OF CLINICAL AND TRANSLATIONAL SCIENCE}, author={Cooks, Eric J. and Duke, Kyle A. and Neil, Jordan M. and Vilaro, Melissa J. and Wilson-Howard, Danyell and Modave, Francois and George, Thomas J. and Odedina, Folakemi T. and Lok, Benjamin C. and Carek, Peter and et al.}, year={2022}, month={Apr} }
 @article{zalake_tavassoli_duke_george_modave_neil_krieger_lok_2021, title={Internet-based tailored virtual human health intervention to promote colorectal cancer screening: design guidelines from two user studies}, volume={15}, ISSN={["1783-8738"]}, DOI={10.1007/s12193-020-00357-5}, abstractNote={Abstract To influence user behaviors, Internet-based virtual humans (VH) have been used to deliver health interventions. When developing Internet-based VH health interventions, the developers have to make several design decisions on VH’s appearance, role, language, or medium. The design decisions can affect the outcomes of the Internet-based VH health intervention. To help make design decisions, the current paper presents design guidelines drawn from two studies. The two studies used Internet-based VH health intervention to promote colorectal cancer (CRC) screening. The two studies examined the influence of visual design and the influence of the information medium on user intentions to pursue more health information. In the first study, the qualitative analysis of the focus group (n = 73 users in 13 focus groups) transcripts shows that the VH’s visual realism, the VH’s healthcare role, and the presence of a local healthcare provider’s logo influenced the user perceptions of the intervention. The findings from the focus groups were used to iterate the intervention and derive design guidelines. In the second study (n = 1400), the analysis of online surveys from users after the VH-based intervention showed that to positively influence the user intentions to pursue the health topic further, the results recommend the use of an animated VH to deliver health information compared to other mediums of information delivery, such as text. The analysis also shows that very few user comments were related to the VH’s appearance after visual design iterations in the second study. The design guidelines from the two studies can be used by developers when using VH-based interventions to positively influence users’ intention to change behaviors.}, number={2}, journal={JOURNAL ON MULTIMODAL USER INTERFACES}, author={Zalake, Mohan and Tavassoli, Fatemeh and Duke, Kyle and George, Thomas and Modave, Francois and Neil, Jordan and Krieger, Janice and Lok, Benjamin}, year={2021}, month={Jun}, pages={147–162} }