Abstract A24: Pilot study to improve colon cancer screening for Native Hawaiian men
Authors: Cassel Kevin , Hughes Claire , Higuchi Paula , Fagan Pebbles , Lee Palama , Brady S. Kalani 
Published: March 2017

Purpose: Our pilot study, “No Ke Ola Pono o Na Kane”, used an existing peer-led, health-activated support group model employing the traditional Hawaiian practice of the “hale mua” (men's house) to address health disparities in colon cancer screening among Native Hawaiian men (kane). The hale mua historically provided an opportunity for dialogue among kane about the methods used to sustain families, training needed for the initiation of young men into manhood, and for teaching the traditions of culture and family. Using a community-based approach, we repurposed and integrated this cultural practice into the study to promote health and well-being among Hawaiian men, including the use of Fecal Immunochemical Tests (FIT) in kane over age 50 who have not been screened for colon cancer.

Background: In Hawai‘i, Hawaiian men have one of the highest death rates from colon cancer and are diagnosed at later stages compared to other racial/ethnic and gender groups. Early and regular screening for precancerous lesions can prevent 90% of colon cancers. However, Hawaiian men have limited access and are not as likely as other groups to be screened. Data from the Hawai‘i Behavioral Risk Factors Surveillance System (BRFSS), show that more than 58% of Native Hawaiian men over age 50 have never been screened for colon cancer. Research has demonstrated that community-based social networks may help Hawaiian men adopt healthy behaviors including colon cancer screenings. However, few studies have focused on utilizing existing social networks to promote colon cancer screening among Native Hawaiian men.

Methods: Our pilot study was conducted statewide in Hawaii in 2015 over a 16 month period. Study staff adapted an existing peer-led model and recruited community volunteers to help deliver the intervention. Using a community participatory approach, No Ke Ola Pono o Na Kane's education and discussion sessions were directed by a set of 3 Native Hawaiian facilitators including: 1) an Alaka‘i (leader); 2) a Kokua (scribe/support person); and 3) a Kauka (physician). The sessions were delivered through use of a standardized set of education and training materials. The session topics included: 1) a No Ke Ola Pono o Na Kane overview 2) Colorectal/Na‘au Health, 3) Lung Health, and 4) Oropharyngeal/Po‘o and Pu‘u Health. Each community site offered at least 3 of the 4 sessions. Each session's health education component was delivered using a large printed flip chart. The flip chart content followed a standardized structure which included: 1) facilitator instructions; 2) a Mo‘olelo, a Hawaiian proverb that frames the health topic; 3) key facts; 4) a health-related discussion question; and 5) a wrap-up and evaluation. This standardized structure minimized the need for rigorous training for men to conduct the sessions confidently.

Results: During the first year, a total of 170 kane attended one or more of the 20 statewide sessions. Attendance at each session averaged between 15-20 men, with 59% of men age 50 or over. Data from a survey of the 63 men attending the colon health session showed that 90% improved their knowledge about colon health, and approximately 50% (N=31) had not had a doctor discuss colon health or screening with them. Twenty five of the 63 kane who attended the colon sessions were eligible to take the FIT, five had been previously screened and 12 completed the tests with negative results. The overall session evaluations demonstrated that more 90% of men liked the hale mua approach and benefited from talking with other men about their health.

Conclusions: This pilot study provided the initial proof-of-principal for our strategy to utilize the hale mua and social support to recruit Hawaiian men to participate in a colon screening education program and to adopt use of the FIT. The pilot data can be used to develop a larger randomized trial that examines how participation and content of sessions is associated with screening uptake.

Citation Format: Kevin Cassel, Claire Hughes, Paula Higuchi, Pebbles Fagan, Palama Lee, S. Kalani Brady. Pilot study to improve colon cancer screening for Native Hawaiian men. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A24.