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Recruiting Chinese Americans into cancer screening intervention trials: strategies and outcomes.

ABSTRACT: Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are underrepresented in cancer research and report poor adherence to cancer screening guidelines.This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. Findings will inform effective strategies for promoting Asian American participation in cancer control research.Chinese Americans who were non-adherent to annual mammography screening guidelines (Study 1 with 664 immigrant women > 40 years of age) and to colorectal cancer screening guidelines (Study 2 with 455 immigrants > 50 years of age) were enrolled from the greater Washington DC, New York City (NYC), and Philadelphia (PA) areas. Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent. Study 1 adopted community approaches and worked with community organizations to enroll participants. Study 2 randomly selected potential participants through 24 Chinese American primary-care physician offices, and mailed letters from physicians to enroll patients, followed by telephone calls from research staff. The success of recruitment approaches was assessed by yield rates based on number of participants approached, ineligible, and consented.Most participants (70%) of Study 1 were enrolled through in-person community approaches (e.g., Chinese schools, stores, health fairs, and personal networks). The final yield of specific venues differed widely (6% to 100%) due to various proportions of ineligible subjects (2%-64%) and refusals (0%-92%). The Study 2 recruitment approach (physician letter followed by telephone calls) had different outcomes in two geographic areas, partially due to differences in demographic characteristics in the DC and NYC/PA areas. The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach (p < .001). Enrollment cost is provided to inform future research studies.Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American populations because they may vary by study protocols (e.g., length of trials), target populations (i.e., eligibility criteria), and available resources.Use of multiple culturally relevant strategies (e.g., building trusting relationships through face-to-face enrollment, use of bilingual and bicultural staff, use of a physician letter, and employing linguistically appropriate materials) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical settings. Our data demonstrate that substantial effort is required for recruitment; studies need to budget for this effort to ensure the inclusion of Asian Americans in health research.

SUBMITTER: Wang JH

PROVIDER: S-EPMC3972290 | biostudies-other | 2014 Apr

REPOSITORIES: biostudies-other

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Recruiting Chinese Americans into cancer screening intervention trials: strategies and outcomes.

Wang Judy Huei-yu JH Sheppard Vanessa B VB Liang Wenchi W Ma Grace X GX Maxwell Annette E AE

Clinical trials (London, England) 20140224 2

<h4>Background</h4>Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are underrepresented in cancer research and report poor adherence to cancer screening guidelines.<h4>Purpose</h4>This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. ...[more]

PMID: 24567288

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Project description:BackgroundCancer is the leading cause of death among Chinese Americans (CAs). Although death rates of cancers can be significantly reduced by screening cancers at an early stage, cancer screening (CS) rates are low among CAs. Interventions on CS may increase the uptake rates of CS and help to decrease the death rates of cancers in CAs.ObjectivesThis study aims to summarize the intervention methods on CS among CAs and compare effects of various intervention methods on the outcomes of CS, including knowledge levels of CS, intentions to complete CS, and actual completions of CS.MethodsA systematic review and meta-analysis design was used. Keyword searching was conducted on PubMed, Google Scholar, PsycINFO, and CINAHL. Inclusion and exclusion criteria were applied. The PEDro scale was used to evaluate the quality of the studies. Data was analyzed using Review Manager Version 5.4 software. Random effect model and subgroup analyses were conducted.ResultsThe search yielded 13 eligible studies. All of the reviewed interventions were culturally tailored. Systematic review results were categorized by intervention delivery objects, intervention led, intervention contact, intervention types, and intervention focus according to group consensus. Meta-analysis results showed that the interventions on CS had a positive effect on all outcomes, including a 1.58 (95% CI, 1.17-2.14; P = 0.003), 1.78 (95% CI, 1.27-2.48; P = 0.0007), and 1.72 (95% CI, 1.22-2.42; P = 0.002) effect on knowledge of CS, intentions to complete CS, and completions of CS, respectively, compared to the control group. The subgroup analysis suggested that physician-led, individual-based, face-to-face client-focused interventions with multiple components increased CS among CAs, with the OR ranging from 1.60 (95% CI, 1.08-2.39; P = 0.02) to 3.11 (95%CI, 1.02-9.49; P = 0.05).DiscussionInterventions on CS significantly increased CAs' knowledge of CS, intentions to complete CS, and completions of CS. Physician-led, individual-based, face-to-face client-focused interventions with multiple components should be utilized for CAs.

Project description:ObjectivesCancer is the leading cause of death among Asian Americans. Chinese Americans comprise the largest Asian American ethnic group. Low health literacy (LHL) is associated with lower cancer screening rates, but this association has not been studied in Chinese Americans. We examined the relationship between LHL and meeting US Preventive Service Task Force (USPSTF) guidelines for cervical, colorectal and breast cancer screening among Chinese Americans.DesignObservational study of Chinese respondents in the 2007 California Health Interview Survey, a population-based survey. Interview languages included English, Cantonese and Mandarin.SettingCalifornia, USA PARTICIPANTS: Chinese respondents in age/gender groupings appropriate for USPSTF cancer screening guidelines (cervical: women ages 21-65, n=632; colorectal: men or women ages 50-75, n=488; and breast: women ages 50-74, n=326).OutcomesRelationships were tested using multivariable logistic regression models controlling for healthcare access and demographic factors, including limited English proficiency (LEP). The combined effects of having both LHL and LEP were specifically examined. LHL was measured by 2-items on perceived ease-of-use of written medical materials. All study variables were self-reported.ResultsCancer screening percentages among Chinese Americans were 77.8% for cervical, 50.9% for colorectal (47.9% for women and 54.2% for men), and 85.5% for breast. LHL was associated with lower odds of meeting breast cancer screening guidelines (OR 0.41; 95% CI 0.20 to 0.82). Respondents with both LHL and LEP were significantly less likely to have up-to-date colorectal (OR 0.49; 95% CI 0.25 to 0.97) and breast cancer screening (OR 0.21; 95% CI 0.08 to 0.54) than those with neither health communication barrier. In all multivariable models, having seen a physician in the past year was a significant predictor of an up-to-date screening.ConclusionsIn Chinese Americans, LHL and LEP were negatively associated with up-to-date breast and colorectal cancer screening, independent of a recent physician visit. Efforts to promote cancer screening among Chinese Americans should consider and address LHL, LEP and physician access barriers.

Project description:IntroductionChinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans.DesignCluster randomized comparative trial.Setting/participantsFrom 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin.InterventionLay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls.Main outcome measuresChange in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015.ResultsThis study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%-88.3%, p<0.0001; Print, 72.3%-79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%-78.1%, p<0.0001; Print, 58.1%-64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date.ConclusionsBoth in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants.Trial registrationThis study is registered at www.clinicaltrials.gov NCT00947206.

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Recruiting Chinese Americans into cancer screening intervention trials: strategies and outcomes.

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Recruiting Chinese Americans into cancer screening intervention trials: strategies and outcomes.

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