ARE CULTURALLY TARGETED PATIENT DECISION AIDS MORE EFFECTIVE? UNEXPECTED RESULTS FROM THREE RANDOMIZED EXPERIMENTS

Purpose:    Theory-based models predict superior results from cultural targeting of patient decisions aids (PDAs). However, these models remain untested. Three studies in two disease conditions were conducted to examine effects of culturally targeted versus non-targeted PDAs.

Method:  Researchers ran two experiments in breast cancer and diabetes contexts. A third experiment retested the first breast cancer study using a different design. Online panels of self-identified Hispanic women in the U.S. read a disease scenario and imagined a recent diagnosis. They were randomly assigned to a culturally targeted (ethnic imagery, linguistics, values, narratives) or non-targeted PDA prior to consultation. An expert on Hispanic health communication helped develop targeted versions and focus groups of Hispanic women reviewed culturally relevant content. Standard outcome measures associated with PDA evaluation research were collected. Manipulation checks showed high awareness of cultural information only in the targeted PDA group in each study. Respondents spent eight minutes or more on the task and passed attention filters. Thought listings indicated engagement.

Results: Sample demographics were similar in all three studies (e.g., Hispanic women, age 40-55; English capable; modal categories: lower to middle income, some college education, and homemaker). Despite large samples and strong manipulations, only one significant difference in studies 1-2 was detected (see Table). To rule out possible confounds from group-interdependence measures in studies 1-2, study 3 premeasured group-interdependence and a week later, invited participants to take the main part of the breast cancer experiment. Again, non-significant results were obtained. Potential moderators such as group-interdependence, ethnic identification strength, and years in the U.S. did not interact with PDA treatment in any study.

Conclusions: Recent cultural psychology research sheds light on possible reasons for null PDA targeting effects across two disease contexts and three studies. First, culture appears to exert its greatest influence when individuals are “thinking fast” or constrained on resources such as time. Other evidence suggests that culture is most influential when processing objectives are less clear and task-specific schema/norms aren't primed. When individuals deliberate and/or are guided by relatively clear processing goals, individual differences and task-related schema/norms are more likely to dominate “shared” cultural values. Three studies suggest that cultural targeting in serious disease contexts, while not harmful, may not enhance pre-consultation objectives as expected with ethnically adapted PDAs.