Background Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic Whites. Hmong Americans have limited socioeconomic resources and literacy. This randomized controlled trial (RCT) was conducted to determine if bilingual/bicultural lay health educator (LHE) education can increase CRC screening among Hmong Americans Methods We conducted a cluster RCT among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by a LHE. The control group received education about nutrition and physical activity delivered by a health educator. The outcomes were change in self-reported ever and up-to-date CRC screening after 6 months. Results All participants (n=329) were foreign-born with mostly no formal education, limited English proficiency, and no employment. Most were insured and had a regular place for care. The intervention group had greater changes after the intervention than the control group for ever screening (p=0.068) and being up-to-date (p<0.0001). In multivariable regression analyses, the intervention group had a greater increase than the control group in reporting ever screening (AOR = 1.73, 95% CI: 1.07–2.79) and being up-to-date (AOR = 1.71, 95% CI: 1.26–2.32). Having health insurance had > 4 times the odds for receiving screening, both ever and up-to-date. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. Conclusions A culturally and linguistically appropriate educational intervention delivered by trained LHEs increases colorectal cancer screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Trial Registration Clinicaltrials.gov # NCT01904890

Knowledge regarding the causes of CRC and its prevention among Filipino, Hmong, and Korean individuals is low. However, health care access, not knowledge or beliefs, was found to be a key determinant of CRC screening. Cancer 2018;124:1552-9. © 2018 American Cancer Society.

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