Racial representation affects trust of online prostate cancer content

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"Not only does it impact trust in the information, but a lack of Black representation in prostate cancer content gave the impression that Black men are at lower risk for prostate cancer,” says Stacy Loeb, MD, MSc.

Findings from a recent study indicate that several factors influence Black men’s trust of online content on prostate cancer, including racial representation, the source of the information, website structure, and the appearance of soliciting money.1,2

The participants also expressed higher trust in websites that had a more professional appearance.

The participants also expressed higher trust in websites that had a more professional appearance.

Data from the study were collected via 7 virtual focus groups with 22 Black patients with prostate cancer in 2022 and 2023. During the focus groups, patients completed a questionnaire and participated in a group discussion, which included providing feedback on online content. Most participants indicated that they use the internet to find information regarding prostate cancer.

Overall, feedback from the respondents showed that Black representation was an important factor in their trust of online content. They noted that lack of Black representation gives off the impression that prostate cancer is less likely to affect men of Black race, even though Black men are more likely to get prostate cancer and die of the disease compared with White men.

"Our study shows that representation matters to Black patients seeking prostate cancer information online. Not only does it impact trust in the information, but a lack of Black representation in prostate cancer content gave the impression that Black men are at lower risk for prostate cancer,” said lead author Stacy Loeb, MD, MSc, in a news release on the findings.2 Loeb is a professor of urology and population health at New York University Langone Health in New York, New York.

“Thus, lack of representation could have dangerous consequences such as discouraging screening among Black men,” Loeb added.

These findings corroborate and build upon previous data showing that prostate cancer information included in online videos was viewed as more trustworthy by Black Americans when it was delivered by a physician or patient of the same race.3

In addition to the findings on representation, participants from the current study also mentioned being attentive to the source of the information. Many patients noted that they went to the “about” tab on websites to assess the credentials of the source, and the majority of respondents said that they tended to choose content from specific publishers that they viewed as reputable sources, such as the Mayo Clinic.

The participants also expressed higher trust in websites that had a more professional appearance. Distrust was expressed toward websites that appeared amateur, disorganized, overly flashy, or contained broken links. Websites with commercial leanings also tended to elicit distrust. Even with nonprofit organizations, prominent donation buttons sometimes elicited distrust from the respondents. Further, websites that appeared to be selling alternative therapies or herbal remedies were also viewed as untrustworthy by participants.

Based on these results, the investigators developed a set of 4 recommendations for patient-facing websites that produce medical content on prostate cancer.

  • Racial representation: Creators should ensure that their content features racially diverse individuals in online content on prostate cancer.
  • Reputable source: Experts on prostate cancer should share their content broadly, and health care providers should share trustworthy sites with patients and their families to ensure that they have access to reputable information.
  • Professional website structure: Websites should appear professional and uncluttered and the links and content should remain up to date.
  • Soliciting money: Creators should avoid requests for money or the appearance of financial conflict. Information on alternative medicine should be based on evidence.

The authors concluded, "Underrepresentation of Black adults in prostate cancer content has the potential to worsen prostate cancer health disparities. Optimal online communications should include racially diverse representation and evidence-based information in a professional format from reputable sources without financial conflict."

References

1. Loeb S, Nolasco TS, Byrne N, et al. Representation matters: Trust in digital health information among Black patients with prostate cancer. J Urol. 2024;211(3):376-383. doi:10.1097/JU.0000000000003822

2. For Black patients, ‘representation matters’ in evaluating prostate cancer websites. News release. Wolters Kluwer Health: Lippincott. February 9, 2024. Accessed February 12, 2024. https://www.newswise.com/articles/for-black-patients-representation-matters-in-evaluating-prostate-cancer-websites

3. Loeb S, Ravenell JE, Lin Gomez S, et al. The effect of racial concordance on patient trust in online videos about prostate cancer: A randomized clinical trial. JAMA Netw Open. 2023;6(7):e2324395. doi:10.1001/jamanetworkopen.2023.24395

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