Cancer
Volume 123, Issue 1, 2017, Pages 98-106

Lay health educators increase colorectal cancer screening among Hmong Americans: A cluster randomized controlled trial (Article)

Tong E.K.* , Nguyen T.T. , Lo P. , Stewart S.L. , Gildengorin G.L. , Tsoh J.Y. , Jo A.M. , Kagawa-Singer M.L. , Sy A.U. , Cuaresma C. , Lam H.T. , Wong C. , Tran M.T. , Chen M.S., Jr.
  • a Department of Internal Medicine, University of California at Davis, Sacramento, CA, United States
  • b Department of Internal Medicine, University of California at San Francisco, San Francisco, CA, United States
  • c Hmong Women's Heritage Association, Sacramento, CA, United States
  • d Department of Public Health Sciences, University of California at Davis, Sacramento, CA, United States
  • e Department of Internal Medicine, University of California at San Francisco, San Francisco, CA, United States
  • f Department of Psychiatry, University of California at San Francisco, San Francisco, CA, United States
  • g University of New Mexico at Albuquerque, Albuquerque, NM, United States
  • h Fielding School of Public Health and Asian American Studies Center, University of California at Los Angeles, Los Angeles, CA, United States
  • i University of Hawai‘i at Manoa, Manoa, HI, United States
  • j University of Hawai‘i at Manoa, Manoa, HI, United States
  • k Department of Internal Medicine, University of California at San Francisco, San Francisco, CA, United States
  • l Department of Internal Medicine, University of California at San Francisco, San Francisco, CA, United States
  • m Department of Internal Medicine, University of California at San Francisco, San Francisco, CA, United States
  • n Department of Internal Medicine, University of California at Davis, Sacramento, CA, United States

Abstract

BACKGROUND: Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans. METHODS: A cluster randomized controlled trial was conducted among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by an LHE. The control group received education regarding nutrition and physical activity delivered by a health educator. The outcomes were changes in self-reported ever-screening and up-to-date CRC screening after 6 months. RESULTS: All 329 participants were foreign-born with mostly no formal education, limited English proficiency, and no employment. The majority of the participants were insured and had a regular source of health care. The intervention group experienced greater changes after the intervention than the control group for ever-screening (P =.068) and being up-to-date with screening (P<.0001). In multivariable regression analyses, the intervention group demonstrated a greater increase than the control group in reporting ever-screening (adjusted odds ratio, 1.73; 95% confidence interval, 1.07-2.79) and being up-to-date with screening (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32). Individuals who had health insurance were found to have >4 times the odds of receiving screening, both ever-screening and up-to-date screening. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. CONCLUSIONS: A culturally and linguistically appropriate educational intervention delivered by trained LHEs was found to increase CRC screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Cancer 2017;98–106. © 2016 American Cancer Society. © 2016 American Cancer Society

Author Keywords

Screening lay health educator disparities Colorectal cancer Hmong

Index Keywords

physical activity unemployment educational status mass screening Hmong American Health Educators health insurance human Self Report language ability Odds Ratio middle aged colorectal cancer controlled study priority journal early cancer diagnosis Aged Colorectal Neoplasms cancer screening randomized controlled trial sigmoidoscopy occult blood Early Detection of Cancer Insurance, Health procedures health educator Confidence interval cluster analysis United States social status Humans psychology California Asian Americans male Asian American colonoscopy female cultural factor Article major clinical study adult health education health care access nutritional health health literacy bilingualism Multilingualism behavior change
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84983628361&doi=10.1002%2fcncr.30265&partnerID=40&md5=0b9b497aaee31c1a8eee1565fafae642
DOI: 10.1002/cncr.30265
ISSN: 0008543X
Cited by: 13
Original Language: English