Methods: Microworlds simulate a small part of the real environment and use concepts from constructivist learning in order to engage and contextualized the content for the user. To aid women in navigating through the open learning environment, a pedagogical agent named Dafna was utilized. Eligible subjects included 61 English-speaking females (31 African American, 6 Hispanic, and 24 white) at increased risk for breast cancer (5-year risk Ан 1.7%). Participants were randomly assigned to either an intervention group (n= 39) that viewed the microworlds decision aid or a control group (n=22) that used an audiobooklet with similar content. Measures of core knowledge, decisional conflict, and risk perceptions were collected prior to viewing the aid (baseline), immediately after viewing the aid, and 2-weeks after initial viewing.
Results: The mean age was 61.5 years. Patients in the microworlds group spent an average of 62 minutes viewing the program (range 37 to 147 minutes). Knowledge improved for both groups from the baseline to two-week follow-up (P<.05), although larger gains were noted for the microworlds group. Similarly, patients in both groups became more assured of their breast cancer risk reduction strategies (P<.01), but again the effects were larger for the microworlds group. While not statistically significant, microworlds patients (83.8%) were more likely to recognize themselves at a higher risk of breast cancer than audiobooklet patients (62.2%). Patients' ratings of the microworlds program and audiobooklet were similar and highly favorable. Patients who viewed the microworlds decision aid rated the pedagogical agent as highly valuable for enhancing learning, as well as having a positive social presence (i.e., engaging, entertaining) with human-like expressions and communication.
Conclusions: Microworld learning environments, which include a pedagogical agent, especially designed to aid those with limited literacy, is a potential strategy for enhanced risk communications and informed decision making in breast cancer prevention.