Alcohol and red/processed meat consumption are two diet-related risk factors for colorectal cancer (CRC). Informing patients of personal nutrition risk factors for CRC may help to stimulate accurate CRC risk perceptions and facilitate CRC prevention behaviors. For rural adults at risk for CRC, technology may help overcome disparities that affect CRC risk such as low screening rates, poor diet, low literacy, and limited access to healthcare. This diversity supplement is connected to an R01 awarded to Dr. Janice Krieger (1R01CA207689-01A1) titled ?A Patient-Centered Intervention using Technology to Reduce Colorectal Cancer Disparities in Primary Care?. This proposed diversity supplement adds a nutrition module delivered in a virtual environment to enhance the personal relevancy of CRC risk information and encourage CRC prevention behaviors in two ways. First, virtual health assistants (VHAs) will collect patient reported outcomes (PROs) specific to alcohol and red/processed meat consumption. Second, VHAs will present participants with personalized nutritional risk information using visual and graphic content. Focus groups and think-aloud interviews with rural adults between the ages of 50-73 years old will ensure the nutrition module is culturally and socially relevant and presents appropriate content and messages. Focus groups will use storyboards to depict components of the planned nutrition module that will be added to the existing CRC screening intervention. Using an iterative approach, we will modify the nutrition module to include an interactive and visually engaging process of reporting and receiving tailored feedback for alcohol and meat consumption in the virtual environment. We will then test the nutrition module for usability with think-aloud interviews. We will pilot test the intervention among black and white rural adults. We will use a pre-post, 3-group randomization with participants receiving the VHA-delivered tailored nutrition module (n=30), text-based tailored nutrition module (n=30), or attention control module (n=30) on a web-enabled computer or tablet. We will test if the intervention increases 1) accurate CRC risk perceptions, 2) intentions to screen for CRC 3) and information seeking behaviors to reduce alcohol and red/processed meat intake compared to the tailored text-based nutrition module or attention control condition. This project builds upon prior and ongoing work that leverages virtual human technology to increase CRC screening among rural populations and racial minorities. We test if patient engagement with nutrition risk factors delivered in a virtual setting can stimulate accurate risk perceptions and promote CRC prevention behaviors. Findings will inform optimal message design for CRC prevention and test the impact of concreate representations of risk on CRC prevention goals. Long-term, the goal of this work is to integrate the nutrition module within healthcare systems to facilitate collection of nutrition PROs for CRC prevention. The CRC intervention and nutrition module delivered with virtual human technology is a scalable and affordable intervention with potential to increase screening rates in rural and underserved areas.

Public Health Relevance

This project uses insights from rural adults to inform an interactive nutrition module for use in an existing colorectal cancer (CRC) screening intervention. This is the first project that uses virtual health assistants to collect nutritional risk factors for CRC as patient reported outcomes (PROs) that can integrate into the electronic health record. Outcomes will contribute to knowledge of what message design components are effective at stimulating accurate CRC risk perceptions and promoting screening behaviors among rural adults.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Kobrin, Sarah
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University of Florida
Schools of Arts and Sciences
United States
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