Abstract A29: Disseminating colorectal cancer screening guidelines in Asian-American communities using a market-oriented and multilevel approach
Authors: Kim Karen , Quinn Mike , Chandrasekar Edwin , Patel Reena , Lam Helen 
Published: March 2017

BACKGROUND There was a significant increase in colorectal cancer (CRC) screening rates in the U.S. population between 2008 and 2010; however, Asian Americans (AA) remained the only racial/ethnic subgroup without any improvement and was at 47%. Therefore, accelerating the dissemination and adoption of CRC screening guidelines in the AA communities has the potential to reduce unnecessary cancer burden. The traditional top-down dissemination model views communities as passive distribution or delivery systems rather than as rich sources of knowledge and skills and dynamic places in which prevention programs will ultimately need to survive and thrive. In this study, we developed a community-centered dissemination model using a multilevel approach to accelerate the adoption of CRC screening guidelines in seven Asian communities.

METHODS We integrated a market-oriented Push-Pull-Infrastructure framework with Diffusion of Innovation Theory, and Community-Based Participatory Research (CBPR) to create a community-centered dissemination model. Community focus groups were conducted to identify salient CRC screening beliefs and attitudes, and were used to develop survey measures to more broadly sample community residents. Findings from the survey were used to develop both training content for community outreach and tailored social marketing campaigns for our intervention. The seven partner AA communities were randomly divided into two cohorts. A wait-list cross-over random design was used to evaluate the effectiveness of our outreach intervention. Primary outcomes included educational session attendance, Fecal Immunochemical Test (FIT) kits distribution and returned rates. Data were collected over three different time periods.

RESULTS Collaboration took place between an academic institution and eight community-based organizations from seven Asian subgroups (Cambodian, Chinese, Filipinos, Korean, Laotian, South Asians and Vietnamese). A sample of 72 AAs participated in focus groups, and differences were noted across ethnic subgroups. Furthermore, 464 community members participated in a community-wide survey. Most participants agreed that early detection of cancer was important (94%) and cancer could happen to anyone (87%). However, 36% of participants also felt that people were better off not knowing they had cancer, and 46% would screen only when they had symptoms. Outreach activities included distribution of printed educational materials, one-on-one counseling and group education. Across the seven communities, ten community health advisors reached out to over 2,400 community residents over a 12-week intervention period. In cohort 1, 148 people attended the post-intervention education session where no-cost FIT kit was offered compared to 17 people at baseline; while in cohort 2, 101 people attended the post-intervention session compared to 27 at baseline. The screening rates for cohort 1 and 2 were 63% (93/148) and 57% (58/101), respectively. Community screening rates ranged from 100% in Cambodian, 89% in Vietnamese and 84% in Chinese, to 42% in Korean and Filipinos, and 32% in South Asians. After an intensive 12-week outreach activity and social marketing campaigns, significant increase was observed in attendance (p = .010), FIT kits distributed (p = .008) and returned (p = .014) compared to baseline data. A cross-over effect was observed.

CONCLUSION There is a limited research base to inform the design of successful action plans for dissemination and implementation CRC screening guidelines, especially in underserved populations. Our new model outlines a complementary role for researchers and community-based organizations, focuses on understanding potential adopters and incorporates social interaction and influence to move individuals from simple awareness to decisions towards positive action.

Citation Format: Karen Kim, Mike Quinn, Edwin Chandrasekar, Reena Patel, Helen Lam. Disseminating colorectal cancer screening guidelines in Asian-American communities using a market-oriented and multilevel approach. [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 A29.