Factors Associated with Colorectal Cancer Screening Adoption Among Chinese Americans: A Stages of Change Perspective

Background: Colorectal cancer (CRC) screening rates remain low among Chinese Americans. Factors associated with CRC screening adoption in this population are not well understood.

Methods: Cross-sectional data from a convenience sample of 319 Chinese Americans aged 50-75 (23% male; 64% spoke English poorly or not at all) were analyzed to examine factors associated with stage of CRC screening adoption.

Results: Based on self-reports, 55% were in the “Action” stage (up-to-date for screening), 14% in “Contemplation” stage (planned for screening within 6 months), and 31% in Precontemplation stage (no plan for screening). Most (93%) agreed that screening was important. In multivariable analyses, compared to those in Action, Precontemplators were less likely to be insured (Odds Ratio [OR]=0.2, 95% CI: 0.03-1.03), to be worried about getting CRC (OR: 0.2, 95% CI: 0.1-0.5), to believe that screening was easy (OR: 0.3, 95% CI: 0.2-0.7), and to report that a physician had recommended screening (OR=0.1, 95% CI: 0.05-0.2). Compared to Contemplators, Precontemplators were more likely to be female (OR: 3.6, 95% CI: 1.2-10.8), and less likely to be worried about getting CRC (OR: 0.3, 95% CI: 0.1-0.8) and to report that a physician had recommended screening (OR=0.2, 95% CI: 0.1-0.5).

Conclusions: Although most respondents agreed that CRC screening was important for them, one-third had no plan for it. Lack of health insurance, lack of physician recommendation, low perceived susceptibility, and perceived testing difficulty were associated with no screening intention. Efforts to increase CRC screening require multi-level interventions targeting patients, providers and access.