Clara is a healthcare provider who works with Black communities in Boston. Clad in a magenta blouse and a striped head scarf, she greets her patients by name and makes small talk before delving into questions about their diet and exercise. A small, framed cross is visible on the office wall behind her—she’s Christian herself and works predominantly with Black parishes around the city.
Clara isn’t actually a person, though. She’s an animated virtual nurse developed by Timothy Bickmore, a computer science professor at Northeastern. Clara can’t take vital signs or treat wounds, but she can make suggestions and help patients stay on track when it comes to general wellness matters, such as diet, exercise, and mental health.
Now, as COVID-19 vaccines become more accessible in Massachusetts, Clara will have a new job—to provide information about the vaccine to Black Bostonians, many of whom are distrustful of the vaccine, not least because of a long history in the United States of medical abuse and unethical clinical trials involving Black participants.
“There’s a mistrust of the medical establishment based on generations of now-documented mistreatment of African Americans by doctors and the healthcare system in the United States,” says David Wright, executive director of the The Black Ministerial Alliance of Greater Boston, a Christian community organization Bickmore partners with.
“These vaccines were also created under an administration known for not telling the truth and using racist and xenophobic language,” Wright says. “Unsurprisingly, there’s a mistrust of anything made under that administration.”
For the past few years, Bickmore has worked with the alliance to promote spiritual and physical health throughout almost 30 Black parishes using his animated healthcare program. The vaccine project will be a continuation of this partnership.
“We hope to provide information about where people can get vaccinated, and what they can expect,” says Bickmore. “We already have a relationship with the community, and they asked if we could help promote COVID-19 vaccines.”
With funding from the National Institutes of Health, Bickmore and his team will launch the vaccine program within the next two months. New vaccine-related phrases will be added to Clara’s wordbank, and participants will be able to ask questions about the vaccine from the comfort of their own homes.
“Even for individuals who don’t have high computer literacy, the program is still easy to use,” he says. “We’ve gotten great feedback. It seems to be working, and most people like it. Most of the time, they’re able to suspend their disbelief and really engage with the program.”
Limited access to smartphones or computers could be an issue for some seniors, but overall, Wright doesn’t think the technology aspect of the program will pose too much of a problem.
“I’d say a significant number of seniors regularly use smartphones,” Wright says. “I suspect the application will catch on as more and more people use it for church and community activities.”
Bickmore and his team go to great lengths to tailor the program to the demographic of people they hope to help, in this case, Black Christians living in Boston. To build rapport, Clara incorporates Bible stories and spiritual language into the sessions.
“The same way any good doctor would build trust with a patient, Clara shares personal information about herself with her patients and remembers things about their lives in order to build a social connection,” Bickmore says.
The program is intended to last four years. In the coming years, if promoting the COVID-19 vaccine becomes a less-pressing issue, the team will also work on promoting influenza vaccines, another inoculation many Black people in the U.S. are hesitant to receive.
“If you look at the literature, the most successful way to gain a patient’s trust is through face-to-face conversation,” says Bickmore. “Our animated counselor simulates just that, and she’s actually particularly good at it.”
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