Chinese and Korean American immigrant experience: A mixed-methods examination of facilitators and barriers of colorectal cancer screening

background: Although colorectal cancer(CRC) is the third leading cause of cancer deaths among Asian Americans, Chinese and Koreans report lower screening rates than Whites and African Americans.

objective: To examine facilitators and barriers of CRC screening among Chinese and Korean Americans.  

methods: This study used quantitative data from surveys and qualitative data from 12 focus groups.  Surveys were completed by 120 Chinese and Korean American focus group participants aged 50-75.  All participants were asked to discuss non-cultural and cultural facilitators and barriers of CRC screening.  

results: Participants who i)thought colonoscopy was embarrassing and ii)were anxious about colonoscopy were 3.8 and 4.3 times more likely to not be screened, respectively.  Participants who believed colonoscopy is not needed when there are no symptoms were 16 times more likely to not be screened. Similarly, focus group participants indicated that they did not want to use time and money when they do not have symptoms since prevention is not a priority.  Those who i)were recommended screening by doctors and ii)had a regular doctor were 8 and 5.2 times more likely to do the screening, respectively.  Cultural factors that impeded CRC screening included fear of finding cancer, complex healthcare system compared to China/Korea, language barriers, fatalism, and high pain tolerance.  Participants expressed concerns about burdening the family due to their dependence on family for logistical needs and causing emotional hardship if diagnosed with CRC.

conclusions: Strategies that address the identified facilitators and barriers can increase CRC screening and reduce CRC related deaths in these populations.