# Design and Validation of a Chatbot-Based Cervical Cancer Screening Decision Aid for Women Experiencing Socioeconomic Disadvantage: User-Centered Approach Study

## TL;DR

A chatbot called AppDate-You was developed to help socioeconomically disadvantaged women in France make informed decisions about cervical cancer screening, showing promising results in improving access and screening intentions.

## Contribution

The study introduces a user-centered chatbot designed specifically for socioeconomically disadvantaged women to support cervical cancer screening decisions.

## Key findings

- 80% of beta participants expressed interest in HPV self-sampling after using the chatbot.
- Users found the chatbot innovative, user-friendly, and informative despite limited digital literacy.
- Healthcare professionals were surprised by the willingness of diverse women to use the tool.

## Abstract

Cervical cancer (CC) screening participation remains suboptimal among vulnerable populations in France. This study aimed to develop and evaluate AppDate-You, a chatbot-based decision aid, to support women from socioeconomically disadvantaged areas in the French Occitanie region to make informed decisions about CC screening, particularly human papillomavirus self-sampling (HPVss).

This study aimed to explore the needs, preferences, and barriers related to CC screening and to design and validate a user-centered, empathetic, and effective chatbot-based decision aid to empower women experiencing socioeconomic challenges in France to make informed choices about HPVss.

The chatbot was developed following a validated framework for developing decision aids. The process included qualitative research involving online and in-person interviews and focus groups with women and health care professionals, followed by alpha testing with both groups and beta testing with women only. Participants included women (both French and non-French speaking) aged between 30 and 65 years from socioeconomically disadvantaged areas of the Occitanie region and health care professionals (general practitioners, gynecologists, and midwives) working with these populations. AppDate-You was made accessible through WhatsApp and Facebook Messenger, offering text-based and voice-based interactions and multimedia content.

The exploratory phase identified key barriers to screening and digital tool preferences. Prototype testing revealed great satisfaction with the chatbot’s performance, educational value, and content quality. Contrary to the expectations of health care professionals, women from diverse backgrounds, including women who were older and socioeconomically disadvantaged, were willing and able to use the tool. Users—even those with limited digital literacy—found AppDate-You innovative, user-friendly, and informative. In the beta testing phase, 80% (12/15) of the participants expressed interest in HPVss. Some limitations were identified, such as the chatbot’s occasional repetitive responses and the need for clearer medical terminology.

This study demonstrates the potential for artificial intelligence chatbots to improve access to health education and increase cervical screening intention among underserved populations. The user-centered approach resulted in a tool that effectively meets the needs of the target population.

RR2-10.2196/39288