Designing and Evaluating a Digital Family Health History Tool for Spanish Speakers.

Cerda Diez M1, E Cortés D2,3, Trevino-Talbot M1, Bangham C1, Winter MR4, Cabral H5, Norkunas Cunningham T1, M Toledo D6, J Bowen D7, K Paasche-Orlow M8, Bickmore T9, Wang C1.

Author information

1: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
2: Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA 02141, USA.
3: Department of Psychiatry, Harvard Medical School, Cambridge, MA 02139, USA.
4: Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA 02118, USA.
5: Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA.
6: Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
7: Department of Bioethics and Humanities, School of Public Health, University of Washington, Seattle, WA 98195, USA.
8: Department of Medicine, Boston University School of Medicine, Boston, MA 02218, USA.
9: College of Computer and Information Science, Northeastern University, Boston, MA 02115, USA.

Abstract

Digital family health history tools have been developed but few have been tested with non-English speakers and evaluated for acceptability and usability. This study describes the cultural and linguistic adaptation and evaluation of a family health history tool (VICKY: VIrtual Counselor for Knowing Your Family History) for Spanish speakers. In-depth interviews were conducted with 56 Spanish-speaking participants; a subset of 30 also participated in a qualitative component to evaluate the acceptability and usability of Spanish VICKY. Overall, agreement in family history assessment was moderate between VICKY and a genetic counselor (weighted kappa range: 0.4695 for stroke-0.6615 for heart disease), although this varied across disease subtypes. Participants felt comfortable using VICKY and noted that VICKY was very likeable and possessed human-like characteristics. They reported that VICKY was very easy to navigate, felt that the instructions were very clear, and thought that the time it took to use the tool was just right. Spanish VICKY may be useful as a tool to collect family health history and was viewed as acceptable and usable. The study results shed light on some cultural differences that may influence interactions with family history tools and inform future research aimed at designing and testing culturally and linguistically diverse digital systems.

KEYWORDS:

Spanish language; conversational agent; e-health; ethnic/racial minorities; evaluation of genomic tools for public health; family health history; genetic communication; health disparities; health literacy; public health genetics