Lay Health Workers and Colorectal Cancer Screening Among Chinese Americans
| Status: | Completed |
|---|---|
| Conditions: | Colorectal Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 50 - 75 |
| Updated: | 5/5/2014 |
| Start Date: | September 2009 |
| End Date: | July 2014 |
| Contact: | Tung T Nguyen, MD |
| Email: | tung.nguyen@ucsf.edu |
| Phone: | 415-514-8659 |
This proposed project seeks to expand understanding of what constitutes a "lay health worker
(LHW)," how those characteristics determine the effectiveness of LHWs as health educators on
colorectal cancer (CRC) screening, and the relationship of those characteristics to a
particular community and culture. Using quantitative and qualitative methods and a
community-based participatory research (CBPR) approach, the project will develop and
implement a group randomized controlled trial to evaluate LHW effectiveness in promoting CRC
screening among Chinese Americans age 50 to 75 with a pilot component to evaluate the role
of Traditional Chinese Medicine (TCM) healers as health educators.
The investigators will conduct focus groups with community participants to revise training
materials developed in a prior pilot project. The investigators will also conduct
ethnographic observations of TCM healers and focus groups with their clients to refine the
training materials. The investigators will recruit 26 LHWs to be assigned to the
intervention arm and 26 to the comparison arm. The LHWs will each recruit 12 participants
from their social network for a total of 312 participants in each arm. The intervention
group participants will be exposed to 2 LHWO sessions and 2 telephone calls aimed at
increasing their CRC screening receipt. The comparison group will receive a bilingual CRC
brochure as well as a lecture on healthy nutrition for cardiovascular health and a
post-intervention LHWO session on CRC screening. Effectiveness of the intervention will be
measured by pre-intervention and post-intervention surveys of community participants' CRC
screening behaviors, with validation of self-reports. An additional 10 TCM healers will
also participate as LHWs. They will each recruit 12 participants for LHWO. There will be
extensive ethnographic observations as well as post-intervention focus groups of LHWO
activities, LHWs, and LHWO participants to assess the factors that contribute to effective
LHWO.
The primary hypothesis is that the increase in the proportion of participants who report
ever having had a CRC screening test in the experimental group (LHWO about CRC) will be
greater than the increase in the comparison group (nutrition education + CRC brochure).
(LHW)," how those characteristics determine the effectiveness of LHWs as health educators on
colorectal cancer (CRC) screening, and the relationship of those characteristics to a
particular community and culture. Using quantitative and qualitative methods and a
community-based participatory research (CBPR) approach, the project will develop and
implement a group randomized controlled trial to evaluate LHW effectiveness in promoting CRC
screening among Chinese Americans age 50 to 75 with a pilot component to evaluate the role
of Traditional Chinese Medicine (TCM) healers as health educators.
The investigators will conduct focus groups with community participants to revise training
materials developed in a prior pilot project. The investigators will also conduct
ethnographic observations of TCM healers and focus groups with their clients to refine the
training materials. The investigators will recruit 26 LHWs to be assigned to the
intervention arm and 26 to the comparison arm. The LHWs will each recruit 12 participants
from their social network for a total of 312 participants in each arm. The intervention
group participants will be exposed to 2 LHWO sessions and 2 telephone calls aimed at
increasing their CRC screening receipt. The comparison group will receive a bilingual CRC
brochure as well as a lecture on healthy nutrition for cardiovascular health and a
post-intervention LHWO session on CRC screening. Effectiveness of the intervention will be
measured by pre-intervention and post-intervention surveys of community participants' CRC
screening behaviors, with validation of self-reports. An additional 10 TCM healers will
also participate as LHWs. They will each recruit 12 participants for LHWO. There will be
extensive ethnographic observations as well as post-intervention focus groups of LHWO
activities, LHWs, and LHWO participants to assess the factors that contribute to effective
LHWO.
The primary hypothesis is that the increase in the proportion of participants who report
ever having had a CRC screening test in the experimental group (LHWO about CRC) will be
greater than the increase in the comparison group (nutrition education + CRC brochure).
The secondary hypotheses are:
1. The increase in the proportion of participants who are up-to-date for CRC screening in
the experimental group will be greater than the increase in the comparison group;
2. The increase in the proportion of participants who intend to obtain CRC screening in
the next 6 months in the experimental group will be greater than the increase in the
comparison group;
3. The increase in the proportion of participants who are aware of CRC screening tests in
the experimental group will be greater than the increase in the comparison group;
4. Self-efficacy is a mediator between intervention and receipt of CRC screening.
5. Knowledge is a mediator between intervention and receipt of CRC screening.
6. Gender is a moderator between intervention and receipt of CRC screening.
Although the pilot project intervention was effective in both men and women, the sample was
too small to determine if there was a gender effect. Based on the extensive literature on
LHWO among women, the intervention may be more effective among women than men.
Additional secondary hypotheses will apply the primary hypothesis and secondary hypotheses
1-3 to individual CRC tests (FOBT, sigmoidoscopy, or colonoscopy) rather than to the
combined outcome.
1. The increase in the proportion of participants who are up-to-date for CRC screening in
the experimental group will be greater than the increase in the comparison group;
2. The increase in the proportion of participants who intend to obtain CRC screening in
the next 6 months in the experimental group will be greater than the increase in the
comparison group;
3. The increase in the proportion of participants who are aware of CRC screening tests in
the experimental group will be greater than the increase in the comparison group;
4. Self-efficacy is a mediator between intervention and receipt of CRC screening.
5. Knowledge is a mediator between intervention and receipt of CRC screening.
6. Gender is a moderator between intervention and receipt of CRC screening.
Although the pilot project intervention was effective in both men and women, the sample was
too small to determine if there was a gender effect. Based on the extensive literature on
LHWO among women, the intervention may be more effective among women than men.
Additional secondary hypotheses will apply the primary hypothesis and secondary hypotheses
1-3 to individual CRC tests (FOBT, sigmoidoscopy, or colonoscopy) rather than to the
combined outcome.
Inclusion Criteria:
- self-identified as Chinese or Chinese Americans
- age 50 to 75
- speak a language that the LHW can speak (Cantonese, Mandarin, and/or English)
- live and intend to stay in SF for at least 12 months
- have no personal history of CRC
- have no medical problems preventing them from attending educational sessions
- willing to participate in a study about health behaviors involving nutrition or CRC
screening
Exclusion Criteria:
- anyone who does not meet the above criteria
- those unable to understand informed consent form written in their language
- those too debilitated to attend educational sessions
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