A Randomized Controlled Trial of a Lay Health Worker Intervention to Promote Colorectal Cancer Screening Among Chinese Americans
Objective/Purpose: Evaluate the efficacy of a lay health worker (LHW) intervention for CRC screening among Chinese Americans aged 50 to 75 using a cluster randomized controlled trial.
Methods: Using a community-based participatory research (CBPR) approach, we trained 58 LHWs (81% women). Each LHW recruited 12-15 participants. LHWs and their participants were randomly assigned to either: 1) CRC intervention with 2 LHW-delivered educational group sessions, 2 telephone calls, and a CRC brochure; or 2) comparison condition with 2 health-educator lectures and 2 telephone calls about nutrition and physical activity and a CRC brochure. All participants answered surveys at baseline and 6 months later. CRC screening ever was defined as self-reported receipt of a fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy ever. Up-to-date CRC screening was defined as FOBT within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years.
Results: The study included 725 participants: 81% women, 99% foreign-born, 96% limited English proficient (LEP), 29% with less than high school education, and 59% with income $20,000/year or less. The 6-month participant retention rate was 99%. CRC screening ever increased more in the intervention (73.9% to 89.2%) than in the control group (72.3% to 79.5%), p=0.009. Up-to-date screening also increased more in the intervention (60.0% to 78.7%) than in the comparison group (58.1% to 64.8%), p=0.001. Multivariable models accounting for LHW cluster and adjusting for sociodemographic variables showed that the LHW intervention was effective in increasing CRC screening ever (OR=1.94, 95% CI, 1.34-2.80) and up-to-date (OR=2.03, 95% CI, 1.41-2.94) compared to the comparison condition.
Conclusion: CBPR yielded a high retention rate and enhanced community capacity for health education. Lay health workers are effective in increasing screening for CRC among immigrant, LEP Chinese Americans.
Learning Areas:Assessment of individual and community needs for health education
Diversity and culture
Implementation of health education strategies, interventions and programs
Describe a lay health worker intervention to increase colorectal cancer screening among Chinese Americans Assess efficacy of the lay health worker intervention
Keyword(s): Asian Americans, Cancer Prevention and Screening
Qualified on the content I am responsible for because: I have been the principal investigator of multiple federally funded grants addressing cancer screening among Asian Americans.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.