Recruiting Chinese Americans into cancer screening intervention trials: Strategies and outcomes

Abstract

Background Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are under-represented in cancer research and report poor adherence to cancer screening guidelines. Purpose This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. Findings will inform effective strategies for promoting Asian American participation in cancer control research. Methods Chinese Americans who were nonadherent to annual mammography screening guidelines (Study 1 with 664 immigrant women >age 40) and to colorectal cancer screening guidelines (Study 2 with 455 immigrants >age 50) were enrolled from the greater Washington DC, New York City (NYC), and Philadelphia (PA) areas. Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent. Study 1 adopted community approaches and worked with community organizations to enroll participants. Study 2 randomly selected potential participants through 24 Chinese American primary care physician offices, and mailed letters from physicians to enroll patients, followed by telephone calls from research staff. The success of recruitment approaches was assessed by yield rates based on number of participants approached, ineligible, and consented. Results Most participants (70%) of Study 1 were enrolled through in-person community approaches (e.g, Chinese schools, stores, health fairs, and personal networks). The final yield of specific venues differed widely (6% to 100%) due to various proportions of ineligible subjects (2% to 64%) and refusals (0% to 92%). The Study 2 recruitment approach (physician letter followed by telephone calls) had different outcomes in two geographic areas, partially due to differences in demographic characteristics in the DC and NYC/PA areas. The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach (p<.001). Enrollment cost is provided to inform future research studies. Limitations Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American populations because they may vary by study protocols (e.g., length of trials), target populations (i.e., eligibility criteria), and available resources. Conclusions Use of multiple culturally relevant strategies (e.g., building trusting relationships through face-to-face enrollment, use of bilingual and bicultural staff, use of a physician letter, and employing linguistically appropriate materials) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical settings. Our data demonstrates that substantial effort is required for recruitment; studies need to budget for this effort to ensure the inclusion of Asian Americans in hea...

Conducting Cancer Research among Culturally and Linguistically Diverse Groups in Australia: A Reflection on Challenges and Strategies

“…Consistent with international studies conducted among immigrant groups [11] – [13] we found that establishing partnerships with ethnic community organizations (ECOs) was critical to the success of our research projects. The creation of such partnerships was made possible by the fact that in Australia, as in other countries, immigrants often seek to ‘find their feet’ by joining ECOs.…”

Recruiting Chinese- and Korean-Americans in Cancer Survivorship Research: Challenges and Lessons Learned

“…Asian-Americans typically display low levels of participation in cancer research due to language barriers [24]. In many studies, the ability to understand and speak English is a criterion for inclusion [4]; thus, the language barrier may be a formidable obstacle to recruiting Asian-Americans who have limited English-language skills.…”

Hepatitis B Screening Practice among Older Chinese in the Greater Washington, DC, Area

“…Research indicates that community-based intervention programs enable effective outreach to culturally isolated Chinese immigrants and promote their mammography screening behavior. 32,33 Hence, developing a culturally and linguistically appropriate community-based HBV intervention program will be our next step to increase HBV screening in older Chinese immigrant patients, therefore allowing further examination of their screening outcomes with valid medical information. Overall, our study has contributed information for future intervention research to effectively reduce HBV infection susceptibility and prevent the development of liver cancer in this at-risk population.…”