Lay Health Workers and Colorectal Cancer Screening Among Chinese Americans
Condition: Colorectal Neoplasms
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      This proposed project seeks to expand understanding of what constitutes a "lay health worker
      (LHW)," how those characteristics determine the effectiveness of LHWs as health educators on
      colorectal cancer (CRC) screening, and the relationship of those characteristics to a
      particular community and culture. Using quantitative and qualitative methods and a
      community-based participatory research (CBPR) approach, the project will develop and
      implement a group randomized controlled trial to evaluate LHW effectiveness in promoting CRC
      screening among Chinese Americans age 50 to 75 with a pilot component to evaluate the role of
      Traditional Chinese Medicine (TCM) healers as health educators.

      The investigators will conduct focus groups with community participants to revise training
      materials developed in a prior pilot project. The investigators will also conduct
      ethnographic observations of TCM healers and focus groups with their clients to refine the
      training materials. The investigators will recruit 26 LHWs to be assigned to the intervention
      arm and 26 to the comparison arm. The LHWs will each recruit 12 participants from their
      social network for a total of 312 participants in each arm. The intervention group
      participants will be exposed to 2 LHWO sessions and 2 telephone calls aimed at increasing
      their CRC screening receipt. The comparison group will receive a bilingual CRC brochure as
      well as a lecture on healthy nutrition for cardiovascular health and a post-intervention LHWO
      session on CRC screening. Effectiveness of the intervention will be measured by
      pre-intervention and post-intervention surveys of community participants' CRC screening
      behaviors, with validation of self-reports. An additional 10 TCM healers will also
      participate as LHWs. They will each recruit 12 participants for LHWO. There will be extensive
      ethnographic observations as well as post-intervention focus groups of LHWO activities, LHWs,
      and LHWO participants to assess the factors that contribute to effective LHWO.

      The primary hypothesis is that the increase in the proportion of participants who report ever
      having had a CRC screening test in the experimental group (LHWO about CRC) will be greater
      than the increase in the comparison group (nutrition education + CRC brochure).
    

Detailed description: 
      The secondary hypotheses are:

        1. The increase in the proportion of participants who are up-to-date for CRC screening in
           the experimental group will be greater than the increase in the comparison group;

        2. The increase in the proportion of participants who intend to obtain CRC screening in the
           next 6 months in the experimental group will be greater than the increase in the
           comparison group;

        3. The increase in the proportion of participants who are aware of CRC screening tests in
           the experimental group will be greater than the increase in the comparison group;

        4. Self-efficacy is a mediator between intervention and receipt of CRC screening.

        5. Knowledge is a mediator between intervention and receipt of CRC screening.

        6. Gender is a moderator between intervention and receipt of CRC screening.

      Although the pilot project intervention was effective in both men and women, the sample was
      too small to determine if there was a gender effect. Based on the extensive literature on
      LHWO among women, the intervention may be more effective among women than men.

      Additional secondary hypotheses will apply the primary hypothesis and secondary hypotheses
      1-3 to individual CRC tests (FOBT, sigmoidoscopy, or colonoscopy) rather than to the combined
      outcome.
    

Intervention name(s): LHWO about CRC; Nutrition Education + CRC brochure
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 2 LHWO sessions and 2 telephone calls aimed at increasing their CRC screening receipt; Bilingual CRC brochure as well as a lecture on healthy nutrition for cardiovascular health and a post-intervention LHWO session on CRC screening.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Chinese Americans; lay health worker outreach; colorectal cancer screening