Abstract B73: Examining colorectal cancer screening barriers and facilitators though a cultural lens: A mixed methods study of Chinese and Korean Americans
Authors: Lee Sunmin , Jung Mary , Lu Xiaoxiao , Sim Jamie , Ng Diane 
Published: May 2016

Background: Among Asian Americans, colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer death. Although screening has been found to significantly reduce CRC mortality, Chinese and Korean Americans continue to report lower CRC screening rates than White and African Americans. Therefore, this study aims to examine the barriers and facilitators of CRC screening, taking into account a cultural perspective, in these underserved populations.

Methods: We employed a mixed methods study to gain further understanding regarding CRC screening behaviors among Asian Americans. Specifically, we collected quantitative data through surveys from 120 participants, who were self-identified Chinese and Korean Americans, aged 50 years and over. Multivariable-adjusted logistic regression was conducted to analyze survey data, independently assessing for receipt of colonoscopy and fecal occult blood test (FOBT). In addition, qualitative data from 17 key informant interviews (with physicians, health department employees, patient navigators, and community leaders) and 12 focus groups (n=120) were transcribed, translated to English, back-translated to ensure accuracy, coded, and analyzed for salient themes.

Results: Based on focus group findings, major cultural themes influencing CRC screening included language- and health-related attitudes and beliefs. In particular, participants identified having limited English proficiency, low health literacy, and reliance on children for translation as being key barriers. Thus, participants emphasized the importance of having linguistically appropriate services, such as patient navigators. Additional barriers included fearing a CRC diagnosis, having fatalistic views of CRC, and facing stigma towards cancer. In addition, quantitative analysis found that individuals who believed screening is not needed when asymptomatic were less likely to receive a colonoscopy (Odds Ratio (OR): 0.02; 95% Confidence Interval (CI): 0.002-0.23) and FOBT (OR: 0.16; 95% CI: 0.03-0.72). These findings were supported by key informants and focus group participants, who expressed that Chinese and Koreans often times do not prioritize preventive healthcare and believe that seeking healthcare is not necessary when symptoms are not noticeable. Moreover, this study corroborated previous findings of non-cultural factors influencing CRC screening such as cost, insurance, knowledge, and time -some of which were influenced by underlying cultural attitudes and beliefs. Patient-physician communication was another key influential factor. For instance, those having a doctor talk about [(OR: 6.1; 95% CI: 2.4-15.4) for colonoscopy; (OR: 3.1; 95% CI: 1.1-8.5) for FOBT)] or recommend CRC screening [(OR: 6.6; 95% CI: 2.6-16.7) for colonoscopy; (OR: 4.0; 95% CI: 1.4-11.2) for FOBT)] were more likely to have received screening.

Conclusions: Receipt of CRC screening is influenced by cultural and non-cultural factors, both of which need to be addressed in order to increase screening uptake among Chinese and Korean Americans. These findings can inform the development of more effective CRC screening programs and interventions that are culturally and linguistically tailored to these populations.

Citation Format: Sunmin Lee, Mary Jung, Xiaoxiao Lu, Jamie Sim, Diane Ng. Examining colorectal cancer screening barriers and facilitators though a cultural lens: A mixed methods study of Chinese and Korean Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B73.