Mixed-Method Formative Evaluation and Cultural Adaptation of Digital Health Communication Content and Delivery...

IntroductionLung cancer remains a leading cause of cancer death, though lung cancer screening (LCS) uptake remains low, particularly among low-resource patient populations. LungSMART Utah uses a multi-level approach to promote LCS to patients served by Community Health Centers (CHCs). This paper reports on the formative evaluation and cultural adaptation of the project's patient-facing digital health communication content and delivery, in service of the larger population health effort to promote shared decision-making for LCS.MethodsWe used a mixed-method approach (cross-sectional surveys and usability observations) to evaluate developed content and ensure cultural adaptation to serve all patients within the CHCs. First, a messaging study (N=79) used an online survey to evaluate patient perceptions of content quality and to collect feedback on the quality of content in both English and Spanish. Second, a usability assessment (N=17) employed think-aloud protocols to evaluate user experience and technical delivery.ResultsPatients in the messaging study generally rated content favorably. Content evaluations were similar in English and Spanish, though some participants did suggest phrasing changes. The usability assessment identified critical technical and delivery hurdles, including feeling overloaded by choices for some project components and message sequencing concerns. Cultural adaptation insights from Spanish-speaking participants highlighted the need for conversational alternatives to some formal medical terms, explicit transparency about cost, and addressing access anxiety. All participants indicated noting message content came from the CHCs helped foster trust.ConclusionMixed-method formative evaluation and cultural adaptation provide important insights for developing digital population health tools. Addressing technical delivery gaps and specific community concerns will improve the reach and efficacy of LCS promotion in low-resource settings.