The effects of culturally targeted patient decision aids on medical consultation preparation for Hispanic women in the U.S.: Results from four randomized experiments.

RATIONALE

Do culturally targeted patient decision aids (DAs) better prepare lower-middle and middle-class Hispanic American women for medical decision making compared to DAs designed for the general population? Health promotion evidence indicates that inclusion of cultural values, imagery, linguistics, and health data in a DA will improve ethnic patients' preparation relative to a generic DA; yet, this hypothesis remains untested.

METHOD

Four experiments examined consultation preparation effects of culturally targeted versus generic DAs for Hispanic women living in the United States. Drawing on highly rated online DAs, an experienced Hispanic content developer and Hispanic focus groups worked with researchers to develop culturally targeted digital DAs. Online panels of self-identified Hispanic women in the U.S. were randomly assigned to a targeted or generic DA as part of a scenario-based physician consultation for advanced diabetes (Study 1) or early stage breast cancer (Studies 2-4).

RESULTS

Manipulation checks showed high awareness of cultural information in the targeted DA group. Despite efforts to rule out confounds that could account for null effects, DA cultural targeting did not increase knowledge, decision preparedness, or empowerment or reduce decision conflict in the four randomized experiments. Only individual difference variables (e.g., group interdependence) consistently predicted enhanced DA consultation preparation effects. Related research indicates that culture at the group level may exert less influence when individuals think deliberatively, feel less constrained by limited resources such as time, understand processing objectives, and/or are primed with task-specific schema/norms.

CONCLUSION

Given deeper deliberation and clearly primed processing objectives, personal experiences and task-related schema/norms may have significantly reduced the effects of cultural targeting. Consistent findings from four studies suggest that culturally targeted DAs may not better prepare Hispanic women in the U.S. for medical decision making than generic versions designed for the broader population.