A randomized factorial experiment to optimize the design of a culturally tailored breast cancer screening outreach chatbot intervention

Introduction: The main objective of this study is to assess the effects of chatbot persona and communication style on trust and intention to use for scheduling breast cancer screening (BCS). Methods: We conducted a mixed-methods analysis of a randomized factorial experiment to evaluate different chatbot designs for a BCS intervention. The study protocol is registered on ClinicalTrials.gov (NCT05472064). We tested different conditions in a 2 × 2 experimental design using a Black woman persona presented either as a primary care doctor or a breast cancer survivor and a communication style that was either direct or polite, compared with a control condition. Results: Among the experimental conditions, the doctor-polite condition was the most preferred in terms of both trust and intention to use, compared with the control. Qualitative feedback indicated that the doctor persona and polite communication style were perceived as professional and friendly, respectively. While some participants appreciated representation in the use of a Black woman persona and found it relatable, others perceived it as stereotyping, patronizing, or targeting. Discussion: Overall, both quantitative and qualitative findings indicate that a culturally tailored doctor persona with polite messaging may enhance trust and increase intention to use the chatbot for scheduling BCS through professional interactions that are perceived as warm and friendly. The development of culturally tailored personas should be done with caution to prevent the perpetuation of stereotypes in chatbot persona development.