Abstract C67: Tell a Friend and Save a Life: Investigating the impact of knowledge on colorectal cancer screening behaviors and confidence among Chinese and Korean Americans using a mixed methods approach
Authors: Jung Mary , Lu Xiaoxiao , Chen Julia Cen , Le Daisy , Chen Jingjing , Lee Sunmin 
Published: May 2016

Abstract
Introduction: Colorectal cancer (CRC) screening rates for Chinese and Korean Americans are one of the lowest among all racial and ethnic groups. A lack of knowledge and misconceptions surrounding CRC may be contributing factors of this disparity. Hence in this study, we sought to assess the relationship between knowledge with CRC screening behaviors and confidence among Chinese and Korean Americans.
Methods: We recruited Chinese (n=59) and Korean Americans (n=61), 50 years and older, from the Washington, D.C. metropolitan area. CRC screening knowledge, behaviors, and confidence were assessed individually for participants through surveys and discussed in 12 focus group discussions (n=120). Mixed methods were employed to analyze the quantitative survey data and qualitative focus group data. For surveys, associations were analyzed using multivariate-adjusted logistic regression taking into account age, education, income, family history of CRC, having a regular physician, health insurance, and acculturation.
Results: Based on both quantitative and qualitative analyses, participants exhibited a general lack of knowledge about CRC and CRC screening. About 7 out of 10 participants believed that CRC is usually fatal, and 3 out of 10 participants believed that there is nothing they could do to prevent CRC. In addition, over 50% of participants did not know that CRC screening is recommended from age 50 and that there are different CRC screening tests. Participants alluded to the lack of culturally and linguistically tailored health information as being a probable cause of low levels of CRC knowledge in these populations. However, family and friends were found to play an important role in encouraging screening behaviors and providing CRC-related information. For instance, one focus group participant shared about an occasion where she insisted that a friend and her husband receive CRC screening. The participant stated, “Her husband still calls me a lifesaver” after several polyps were found and removed during his colonoscopy. Individuals having a family member or friend, who received CRC screening or had a history of CRC, tended to have greater CRC knowledge. Furthermore, quantitative data and focus group discussions revealed misconceptions regarding CRC as being a western disease, ensuing false beliefs of having less susceptibility. Moreover, increased knowledge was associated with having confidence in getting screening and receiving CRC screening. In particular, those who believed that CRC screening will decrease chances of dying from CRC were 10.2 times more likely to get a fecal occult blood test (95% confidence interval: 3.9-26.6) and 10.7 times more likely to have a colonoscopy (95% confidence interval: 2.8-40.9).
Conclusions: The combined use of surveys and focus groups provided a more in-depth examination and greater insight into how CRC knowledge impacts screening and confidence. Future efforts to increase CRC screening among Chinese and Korean Americans should (1) utilize family and friends as a channel to increase CRC knowledge and screening and (2) target the identified misconceptions held by these groups.
Citation Format: Mary Jung, Xiaoxiao Lu, Julia Cen Chen, Daisy Le, Jingjing Chen, Sunmin Lee. Tell a Friend and Save a Life: Investigating the impact of knowledge on colorectal cancer screening behaviors and confidence among Chinese and Korean Americans using a mixed methods approach. [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 C67.