Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials

Abstract

Introduction Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans. Design Cluster randomized comparative trial. Setting/participants From 2010 to 2014, a community–academic team conducted this study in San Francisco, CA with Chinese Americans aged 50–75 years who spoke English, Cantonese, or Mandarin. Intervention Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls. Main outcome measures Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6-months post-intervention. Statistical analysis was performed from 2014 to 2015. Results This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9% to 88.3%, p<0.0001; Print, 72.3% to 79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0% to 78.1%, p<0.0001; Print, 58.1% to 64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date. Conclusions Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants. Trial registration ClinicalTrials.gov registry number NCT00947206.

Lay health educators and print materials for the promotion of colorectal cancer screening among Korean Americans: A randomized comparative effectiveness study

“…19,20,22,23 Similarly, Carney et al also found that their intervention had some effect on the Chinese and Vietnamese subgroups, but no effect on the Korean American population despite receptiveness and satisfaction with the program. 19,20,22,23 Similarly, Carney et al also found that their intervention had some effect on the Chinese and Vietnamese subgroups, but no effect on the Korean American population despite receptiveness and satisfaction with the program.…”

“…We were successful in working with the local Korean American community to culturally tailor a program that was previously developed and tested in Chinese and Vietnamese American populations, 19,20,22 and in implementing an RCT in this community. We were successful in working with the local Korean American community to culturally tailor a program that was previously developed and tested in Chinese and Vietnamese American populations, 19,20,22 and in implementing an RCT in this community.…”

“…20,22 The Korean study team revised and modified the English version of these materials in multiple iterations, based on recommendations made by community members in focus groups and interviews during the formative phase of the study (2011)(2012). 20,22 The Korean study team revised and modified the English version of these materials in multiple iterations, based on recommendations made by community members in focus groups and interviews during the formative phase of the study (2011)(2012).…”

“…12 However, this remains well below the Healthy People 2020 goal of 70.5%. [15][16][17][18][19][20][21][22][23][24] In particular, 3 recent RCTs have shown that LHE-led education was effective in increasing CRC screening among Vietnamese, Chinese, and Hmong Americans. [15][16][17][18][19][20][21][22][23][24] In particular, 3 recent RCTs have shown that LHE-led education was effective in increasing CRC screening among Vietnamese, Chinese, and Hmong Americans.…”

Colorectal cancer beliefs, knowledge, and screening among Filipino, Hmong, and Korean Americans

“…One implication for interventions is that there may not be a need to discourage people from having beliefs about CRC prevention if they are not harmful as long as they are also taught about the proven methods. 23 …”