Men's Use of an Internet-Based Decision Aid for Prostate Cancer Screening

Abstract

Most medical organizations recommend informed decision making before undergoing prostate cancer screening. The authors conducted a detailed evaluation of men's use of an interactive, Web-based prostate cancer screening decision aid. Participants (N = 531) were 57 years old (SD = 6.8), 37% were African American, and 92% had Internet access. Men completed 2 telephone interviews, pre- and 1-month post–Web site availability. Half of the sample (n = 256) accessed the Web site. Multivariate analysis revealed that users were more likely than nonusers to be White (OR = 2.37, CI 1.6–3.6), previously screened (OR = 2.13, CI 1.07–4.26), have Internet access (OR = 3.66, CI 1.15–11.58), and to report daily Internet use (OR = 2.58, CI 1.47–4.55). Agreement between self-reported and actual Web site use was moderate (κ = .67). Tracking software revealed a mean of 1.3 (SD = 0.5) log-ons and a median of 38 min per log-on. Of participants, 84% used the values clarification tool, and more than 50% viewed each video testimonial. Baseline screening preference was associated with values clarification tool responses and Web site feedback. This study revealed that, beyond the digital divide, Web site use depended on more than Internet access. Further, electronic tracking of Web site use demonstrated overestimation of self-reported use, high use of interactive features, and effect of baseline screening preference on men's response to the Web site.

Notes

*p < .05.

**p < .01.

⁺Percentages do not add to 100 because of missing data.

*p < .05.

**p < .01.

⁺Percentages do not add to 100 because of missing data.

*p < .05.

**p < .01.

*p < .05.

**p < .01.

⁺Percentages do not add to 100 because of missing data.

*Men who responded to the PCS preference question at Web site entry as certain about their choice to be screened received the two “con screening” video testimonials. Men who responded as uncertain about screening received the two “pro screening” video testimonials. All users had access to the remaining six testimonials.