Abstract A38: Exploring colorectal cancer screening among Chinese Americans using the theory of planned behavior model
Authors: Kim Karen , Chandraskar Edwin , Lam Helen 
Published: October 2015

Objectives: Unlike other cancer screening tests, which rely on early detection, colorectal cancer screening (CRS) provides an opportunity for prevention since most colorectal cancer (CRC) begin as a benign polyp. However, over 20 million people age 50 to 75 in the U.S. have never undergone CRS. Furthermore, lower screening rates were observed among minority groups, especially immigrants with low English proficiency (LEP). Asian Americans are now the most rapidly growing minority group in the U.S and Chinese American is one of the fast growing subgroups. The purpose of this study was to explore Chinese Americans CRS behaviors using the Theory of Planned Behavior model (TPB)

Methods: This study used a prospective, quasi-experimental design. Participants in this study were recruited through a Chinese American community-based organization's homemaker program. The homemaker program has six teams, about 40 homemakers per team, to provide basic care to local elderly clients. The six teams were randomly assigned to one of the three CRS education sessions. Presenters of the educational sessions were all male physicians and different in their race/ethnicity and language capacity: 1) Chinese and Chinese-speaking presenter, 2) Chinese and English-speaking presenter with interpreter; and 3) White and English-speaking presenter with interpreter. A culturally tailored presentation was given during the sessions. Participants who agreed to participate in the study were asked to fill out a bilingual pre- and post-survey. The survey questionnaire included 12 items to determine participants' belief of CRS based on the TPB model: behavioral beliefs, normative beliefs and control beliefs. Each participant was offered a no-cost FOBT kit at the end of the session, and had four weeks to mail back the FOBT kit. The outcomes measures included the intention to have CRS and the return of FOBT card for testing.

Results: A total of 337 homemakers participated in the education sessions, and 224 met the age criterion (≥ 50 years old) and completed the pre and post-survey. There were only 21 male participants. 99% of the participants were foreign-born and 59% had no high school education. Only 13% reported their English speaking skill fair to fluent. About half the participants had a primary care physician and only 27% have ever had CRS. 61% of the participants returned their FOBT within 4 weeks. There were significant differences in the returning rates among the 3 groups with the Chinese and English-speaking presenter group had the highest return rate (72%), follow by White and English-speaking presenter group (61%) and Chinese and Chinese-speaking presenter group (49%) (p = .019). Post belief score had a positive association with post-session intention to screen (p = .001), and post-session intention to screen significantly associated with returning the FOBT card (p = .004) even after controlling for group differences. However, there was no significant association between post-session belief score and the return of FOBT card.

Conclusion: The CRS rates remain suboptimal in the Chinese American population. Our finding suggests that educational sessions not only need to focus on addressing knowledge deficit and clarifying myths, but also need to be motivational to increase intention for screening.

Citation Format: Karen Kim, Edwin Chandraskar, Helen Lam. Exploring colorectal cancer screening among Chinese Americans using the theory of planned behavior model. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A38.