Abstract A82: Heterogeneous demographic and cultural profiles of nonadherent Chinese-American patients to colorectal cancer screening: A latent class analysis.
Authors: Strong Carol , Ji Cheng Shuang , Liang Wenchi , Ma Grace , Brown Roger , Wang Judy Huei-yu 
Published: August 2014

Background: Colorectal cancer (CRC) is one of the leading causes of cancer death for Chinese Americans, but the CRC screenings rates remain low among them. Chinese Americans are one of the fast growing populations in the U.S. Chinese who migrated to the U.S. have increased risk for developing CRC. Hence, it is important to increase Chinese Americans' awareness of CRC risk and improve their screening behaviors. There is limited knowledge about the homogeneity of Chinese Americans who are non-adherent to recommended CRC screening guidelines. Research indicates that identifying the subtypes of patients is advantageous for healthcare providers to tailor their communication with patients by focusing on their particular needs and barriers and that can consequently promote their health-seeking behaviors.

Objective: We examined the homogeneous subgroups of Chinese-American patients who are non-adherent to CRC screening guidelines to better inform clinical practices to effectively promote screening behaviors.

Methods: We used baseline data from an ongoing intervention trial that enrolled non-adherent Chinese-American patients to CRC screening guidelines from 18 primary care clinics from the metropolitan Washington DC, New York, and Philadelphia areas. We used latent class analysis (LCA) to classify 349 non-adherent patients based on their sociodemographics, screening barriers, psychosocial and clinical access factors for CRC screening. After classes were identified, multilevel regression analyses were conducted for class comparison.

Results: The mean age of the overall sample was 59 years old (SD=7.41). About half of the sample was female and also about half were college graduate. About 42% reported having received doctor recommendation for CRC screening, but only 10% had screened for CRC. The best-fitting LCA model described three distinctive classes: Western Healthcare Class (WHC, 35%), Eastern Healthcare Class (EHC, 18%) and Mixed Healthcare Class (MHC, 46%). WHC patients were highly-educated with average 20 years of U.S. residency, high level of English proficiency, the least Eastern views of healthcare and the greatest exposure to physician recommendations, but many reported having no time for CRC screenings. EHC patients were highly-educated seniors and recent immigrants with the least CRC knowledge and the strongest traditional views. MHC patients had low level of education, resided in the U.S. for 20 years, and had relatively long relationships with physicians, but their knowledge and Eastern views were similar to those of EHC patients.

Conclusions: These findings extend previous literature and demonstrate that there are different sociodemographic and psychosocial factors to account for non-adherent screening behaviors of older Chinese immigrants. Training primary care physicians to understand that there are distinctive heterogeneous subgroups among non-adherent patients and recognize patients' different demographic characteristics (i.e. SES status, years in the U.S.) and healthcare beliefs (e.g. cancer screening) during encounters may facilitate physicians' communication with patients to overcome their barriers and consequently promote their screening behaviors.

Citation Format: Carol Strong, Cheng Shuang Ji, Wenchi Liang, Grace Ma, Roger Brown, Judy Huei-yu Wang. Heterogeneous demographic and cultural profiles of nonadherent Chinese-American patients to colorectal cancer screening: A latent class analysis. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A82.