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JU INSIGHT Representation Matters: Trust in Digital Health Information Among Black Patients With Prostate Cancer

By: Stacy Loeb, MD, MSc, PhD (Hon), New York University Grossman School of Medicine, New York, Manhattan Veterans Affairs, New York, New York; Tatiana Sanchez Nolasco, MPH, New York University Grossman School of Medicine, New York; Nataliya Byrne, BA, New York University Grossman School of Medicine, New York; Laura Allen, BA, University of California, San Francisco; Aisha T. Langford, MPH, PhD, Wayne State University, Detroit, Michigan; Joseph Ravenell, MD, New York University Grossman School of Medicine, New York; Scarlett Lin Gomez, MPH, PhD, University of California, San Francisco; Samuel L. Washington III, MD, MAS, University of California, San Francisco; Hala T. Borno, MD, University of California, San Francisco, Trial Library Inc, San Francisco, California; Derek M. Griffith, PhD, Racial Justice Institute and Center for Men’s Health Equity, Georgetown University, Washington, Disctrict of Columbia; Nickole Criner, BSc, University of California, San Francisco | Posted on: 18 Mar 2024

Loeb S, Sanchez Nolasco T, Byrne N, et al. Representation matters: trust in digital health information among Black patients with prostate cancer. J Urol. 2024;211(3):376-383.

Study Need and Importance

Although most adults obtain health information on the internet, the quality of information about prostate cancer is highly variable. Black adults are underrepresented in online content about prostate cancer despite a higher incidence of and mortality from the disease. We conducted a qualitative study to explore the perspectives of Black patients with prostate cancer on the importance of racial representation in online content and other factors influencing trust.

What We Found

Racial representation is an important factor affecting trust in the content. Underrepresentation gave the false impression that Black men are not affected by or have a lower risk of prostate cancer, potentially making them less likely to get screened. A lack of Black representation across multiple online sources also led participants to give up searching for information. Other key themes affecting trust in online content included the importance of a reputable source of information, a professional-appearing design, and absence of any financial conflict or solicitation for money.

Figure. Key themes affecting trust in online prostate cancer content with representative quotes.


A limitation of this study is the inherently small sample size in qualitative research. However, the goal of qualitative research is to provide greater depth of information. Additionally, we were not able to tease out the fullness of what “representation” meant to patients (eg, importance of the role of Black adults in the content).

Interpretation for Patient Care

Health care providers should share a list of vetted online resources with patients and families. Online content about prostate cancer should feature racially diverse individuals, provide up-to-date information from expert sources, and avoid the appearance of financial conflict. It is also critical to diversify the medical workforce and the leadership of prostate cancer—related organizations.