A Single-Arm Interventional Trial of Pepper- Robot Delivered Cancer Education for Adults With Intellectual Disability

Individuals with intellectual disabilities (ID) face significant barriers in accessing healthcare education, including, challenges in understanding complex medical information and communicating with healthcare providers and anxiety1 Traditional methods of education delivery often fail to meet the unique learning needs of this population. Cancer screening is particularly affected by these barriers, leading to lower participation rates and delayed diagnoses 2 Socially assistive robots have demonstrated effectiveness in delivering interactive, engaging, and tailored education, helping individuals with cognitive impairments better understand medical procedures and the importance of preventive care. The integration of robotics in cancer awareness education offers a promising solution by providing an appealing and accessible learning experiences tailored to individuals with ID.

A number of studies have been conducted to investigate the use of social robots in healthcare learning .Findings demonstrate that technology which utilises artificial intelligence, speech recognition, and interactive displays enhance learning among individuals with cognitive impairments3 .A randomised controlled trial conducted in 2021 found the physical presence of the robot played a key role in engaging adults with ID and was valuable in learning as a facilitator of communication4.

Robots can simplify cancer awareness concepts using visual aids, step-by-step explanations, and gamification techniques to improve comprehension and retention. Additionally, research has shown that robots provide a non-judgmental and anxiety-free environment, making it easier for individuals with ID to engage with health education materials5,6.They also positively influence health behaviours and encourage proactive awareness participation7 Interactive robotic assistants have been shown to improve knowledge retention and promote adherence to medical recommendations among individuals with ID 8 Additionally it has also been demonstrated that social robots increase motivation in people with ASD when participating in educational activity9 By fostering independent learning and reducing healthcare disparities, robotics-based education represents a transformative approach to promoting cancer awareness screening and early detection.

'Breaking down Barriers' report10 (2023) is an assessment of the needs of disabled people in accessing cancer awareness services in Ireland. Recommendations to enhance cancer awareness in this population include person centred training and education using materials and assistive technologies to enhance delivery.

To this end the investigators plan to conduct a pilot a clinical trial to deliver Cancer Awareness and Prevention Education using the robot 'Pepper'. The trial will be conducted in collaboration with partners at the Brothers of Charity and colleagues at University of Galway, Galway University Hospital cancer services with support from the National Breast Cancer Research Institute ( NBCRI) ensuring co-design, implementation fidelity, and translation to routine care.

Cancer awareness resources already established by the National Cancer screening service will be utilised.

This pilot will assess feasibility, acceptability, and preliminary effectiveness of a robot-led education intervention to improve knowledge, reduce anxiety, and encourage participation in population-based cancer awareness programmes.

The project aligns with the Irish National Screening Service (NSS) programmes (e.g., Breast Check and Bowel Screen) and leverages accessible educational materials already established by NSS, adapted for delivery by Pepper.

Co-design workshops with adults with ID, caregivers, and Limelight staff will inform: content selection, accessible wording, imagery, session pacing, and anxiety supports. PPI contributors will review the easy-read materials and pilot the interaction flow on Pepper.

Inclusion criteria

• Adults (≥18 years) with an intellectual disability requiring any level of support needs.
• Able to provide informed consent, or where capacity is limited, able to assent with decision support in line
• Attending the disability service day center.
• Sufficient receptive/expressive communication (with supports) to participate in interactive sessions

Exclusion criteria

1 Severe sensory impairments that cannot be reasonably accommodated (e.g., profound hearing/vision loss without assistive solutions available for the session).