ORCID

0000-0003-2987-9509 (Ricks-Santi)

Document Type

Article

Publication Date

2025

DOI

10.1186/s12889-025-23488-4

Publication Title

BMC Public Health

Volume

25

Issue

1

Pages

2516 (1-11)

Abstract

Background

To promote genetic screening among women at risk for hereditary breast and ovarian cancer (HBOC), the American College of Obstetricians and Gynecologists recommends that risk assessment be integrated into practice. Chatbots like the Genetic Information Assistant (Gia®) are increasingly implemented to expand access to hereditary genetic screening. Factors that impact chatbot implementation for HBOC risk screening and women's uptake are not fully realized. To refine implementation strategies prior to full scale implementation, we sought to identify women's perceived facilitators/barriers to adopting Gia screening in a rural population within a large healthcare system in the southern United States.

Methods

We recruited both women who agreed to screen using Gia (and then recommended for genetic testing based on National Comprehensive Cancer Network guidelines) as well as women who opted not to do the screen from three Women's Health clinics (OB/GYN) in a northern rural region of Florida. We conducted in-depth, semi-structured interviews with 17 women (nine adopted the screen, eight did not). We conducted a thematic analysis to identify and further define barriers/facilitators to women's uptake of Gia for HBOC cancer risk screening in obstetrics/gynecology care.

Results

Women identified six factors that inhibited and/or facilitated their willingness to use Gia for screening: 1) cancer risk perception, 2) communication with their clinician, 3) feasibility of screening, 4) fiscal and insurance concerns, 5) technology trust/distrust, and 6) previous genetic testing experience. Findings illustrate how each factor functioned as a facilitator and/or barrier in women's uptake (e.g., technology being trusted for accuracy versus concerns for data privacy and security).

Conclusions

While chatbots can extend women's cancer risk screening access, particularly in rural regions and with college-educated women, systems-level (cost) and individual-level factors (perceived risk, misconceptions about repeating genetic testing) should be addressed to promote adoption. Women's interaction with a clinician may be a key implementation strategy for addressing these factors to personalize the screening opportunity and promote their chatbot screening adoption.

Rights

© The Authors 2025.

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original authors and the source, provide a link to the Creative Commons license, and indicate if you modified the licensed material. You do not have permission under this license to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Data Availability

Article states: "The data that support the findings of this study are included in the study presented. The full dataset was not approved by IRB for open access. Data requests would require IRB approval and should be directed to the lead author (eastonwollney@ufl.edu)"

Original Publication Citation

Wollney, E. N., Sims, S. M., Ricks-Santi, L. J., Eddy, E., Wiesman, D., & Fisher, C. L. (2025). Implementing a chatbot to promote hereditary breast & ovarian cancer genetic screening in women's health: Identifying barriers and facilitators to screening adoption. BMC Public Health, 25(1), 1-11, Article 2516. https://doi.org/10.1186/s12889-025-23488-4

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