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Online Program

321492
A Randomized Controlled Trial of a Lay Health Worker Intervention to Promote Colorectal Cancer Screening Among Chinese Americans


Monday, November 2, 2015 : 3:10 p.m. - 3:30 p.m.

Tung T. Nguyen, MD, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, and Asian American Research Center on Health (ARCH), San Francisco, CA
Kent Woo, MSW, NICOS Chinese Health Coalition, San Francisco, CA
Gem Le, PhD, Division of General Internal Medicine, Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA
Elaine Chow, BA, NICOS Chinese Health Coalition, San Francisco, CA
Janice Tsoh, PhD, Department of Psychiatry, UCSF, San Francisco, CA
Adam Burke, PhD, MPH, LAc, Health Education/Holistic Health Studies, San Francisco State University, San Francisco, CA
Jun Wang, PhD, Academy of Chinese Culture and Health Sciences, Oakland, CA
Ginny Gildengorin, PhD, Department of Medicine, University of California, San Francisco, San Francisco, CA
Susan Stewart, PhD, Division of Biostatistics, University of California-Davis, Davis, CA
Rena Pasick, DrPH, Department of Medicine, University of California, San Francisco, San Francisco, CA
Ching Wong, BS, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
Lei-Chun Fung, MPH, MSW, Health Education Department, Chinatown Public Health Center, San Francisco, CA
Stephen McPhee, MD, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
Audio (mp3) recording Recorded Presentation (mp4)
Background/Significance: Colorectal cancer (CRC) is preventable by screening, yet CRC screening rates are suboptimal for Asian Americans.

Objective/Purpose: Evaluate the efficacy of a lay health worker (LHW) intervention for CRC screening among Chinese Americans aged 50 to 75 using a cluster randomized controlled trial.

Methods: Using a community-based participatory research (CBPR) approach, we trained 58 LHWs (81% women). Each LHW recruited 12-15 participants. LHWs and their participants were randomly assigned to either: 1) CRC intervention with 2 LHW-delivered educational group sessions, 2 telephone calls, and a CRC brochure; or 2) comparison condition with 2 health-educator lectures and 2 telephone calls about nutrition and physical activity and a CRC brochure. All participants answered surveys at baseline and 6 months later. CRC screening ever was defined as self-reported receipt of a fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy ever. Up-to-date CRC screening was defined as FOBT within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years.

Results: The study included 725 participants: 81% women, 99% foreign-born, 96% limited English proficient (LEP), 29% with less than high school education, and 59% with income $20,000/year or less. The 6-month participant retention rate was 99%. CRC screening ever increased more in the intervention (73.9% to 89.2%) than in the control group (72.3% to 79.5%), p=0.009. Up-to-date screening also increased more in the intervention (60.0% to 78.7%) than in the comparison group (58.1% to 64.8%), p=0.001. Multivariable models accounting for LHW cluster and adjusting for sociodemographic variables showed that the LHW intervention was effective in increasing CRC screening ever (OR=1.94, 95% CI, 1.34-2.80) and up-to-date (OR=2.03, 95% CI, 1.41-2.94) compared to the comparison condition.

Conclusion: CBPR yielded a high retention rate and enhanced community capacity for health education. Lay health workers are effective in increasing screening for CRC among immigrant, LEP Chinese Americans.

Learning Areas:

Assessment of individual and community needs for health education
Diversity and culture
Implementation of health education strategies, interventions and programs

Learning Objectives:
Describe a lay health worker intervention to increase colorectal cancer screening among Chinese Americans Assess efficacy of the lay health worker intervention

Keyword(s): Asian Americans, Cancer Prevention and Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator of multiple federally funded grants addressing cancer screening among Asian Americans.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3339.0: Innovative Interventions and Translational Research Addressing Asian American and/or Pacific Islander American Health