• Christine Gunn, Ariel Maschke, Timothy Bickmore, Mark Kennedy, Margaret F Hopkins, Michael D C Fishman, Michael K Paasche-Orlow, and Erica T Warner.
• Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA, 02118, USA. Christine.Gunn@bmc.org.
• J Gen Intern Med. 2020 Apr 1; 35 (4): 106910771069-1077.

BackgroundHalf of women undergoing mammography have dense breasts. Mandatory dense breast notification and educational materials have been shown to confuse women, rather than empower them.ObjectiveThis study used a mixed method, multi-stakeholder approach to assess acceptability of an interactive, computer-animated agent that provided breast density information to women and changes in knowledge, satisfaction, and informational needs.DesignA pre-post survey and qualitative focus groups assessed the acceptability of the computer-animated agent among women. An anonymous, online survey measuring acceptability was delivered to a multi-stakeholder group.ParticipantsEnglish-speaking, mammography-eligible women ages 40-74 were invited and 44 women participated in one of nine focus groups. In addition, 14 stakeholders representing primary care, radiology, patient advocates, public health practitioners, and researchers completed the online survey.InterventionsA prototype of a computer-animated agent was delivered to women in a group setting; stakeholders viewed the prototype independently.Main MeasuresData collected included open-ended qualitative questions that guided discussion about the content and form of the computer-animated agent. Structured surveys included domains related to knowledge, acceptability, and satisfaction. Stakeholder acceptability was measured with a series of statements about aspects of the intervention and delivery approach and are reported as the proportion of respondents who endorsed each statement.Key ResultsSix of 12 knowledge items demonstrated improvement post-intervention, satisfaction with the agent was high (81%), but the number of unanswered questions did not improve (67% vs. 54%, p = 0.37). Understanding of the distinction between connective and fatty tissue in the breast did not increase (30% vs. 26%, p = 0.48). Results of the multi-stakeholder survey suggest broad acceptability of the approach and agent.ConclusionsFindings highlight the benefits of a brief interactive educational exposure as well as misperceptions that persisted. Results demonstrate the need for an evidence-based, accessible intervention that is easy to understand for patients.

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