Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study

Danyell Wilson-Howard, Melissa J. Vilaro, Jordan M. Neil, Eric J. Cooks, Lauren N. Griffin, Taylor T. Ashley, Fatemeh Tavassoli, Mohan S. Zalake, Benjamin C. Lok, Folakemi T. Odedina, Francois Modave, Peter J. Carek, Thomas J. George, Janice L. Krieger

Research output: Contribution to journalArticlepeer-review


Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men.

Original languageEnglish (US)
Article numbere28709
JournalJMIR Formative Research
Issue number12
StatePublished - Dec 2021


  • App
  • Black men
  • Cancer
  • Cancer screening
  • Colorectal cancer
  • Development
  • Digital health
  • EHealth
  • Prevention
  • Technology
  • Telehealth
  • Virtual human

ASJC Scopus subject areas

  • Health Informatics
  • Medicine (miscellaneous)


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