Small Media Interventions to Increase Colorectal Cancer Screening Among Chinese Americans

Chinese Americans are the largest group of Asian Americans, the fastest growing racial
population in the U.S. Colorectal cancer is the second most common cancer among Chinese
Americans. Screening reduces colorectal cancer mortality and is cost-effective but remains
underutilized. Asian Americans and Chinese Americans are less likely than non-Hispanic whites
to be screened for colorectal cancer. Factors associated with lack of screening among Asian
Americans include recent immigration, lower education, lower English fluency, lack of
knowledge, patient-physician language discordance, and lack of physician recommendation.

Although small media and client-reminders are effective in increasing colorectal cancer
screening in the general population, no randomized controlled trial has assessed the effect
of such interventions on Chinese Americans, particularly those who are limited English
proficient. Building on an established community-based participatory research network and
strong preliminary studies, the team propose to develop a culturally and linguistically
appropriate booklet (small print media) and an audio-visual application accessible through
mobile devices and a website (small electronic media) to promote screening. Through an
innovative approach that links community organizations that have cultural and linguistic
expertise to healthcare systems that have many Chinese American patients, the investigators
will test the effect of combining these small media materials and a mailed patient reminder
on the rate of screening for colorectal cancer screening among Chinese Americans in this
Small Media Interventions for Limited English Speakers (SMILES). The investigators have
developed English and Chinese (Cantonese and Mandarin) small print and electronic media
materials to promote colorectal cancer screening among Chinese Americans. This RCT will
compare the efficacy of a combination of mailed patient reminder and small print and
electronic media versus usual care among Chinese American patients who are not up-to-date for
colorectal cancer screening recruited from 3 healthcare systems in a randomized controlled
trial.

Inclusion Criteria:

- Not up-to-date for colorectal cancer screening; self-identified as Chinese or Chinese
American, or Asian who speak Chinese, or Asian born in China.

Exclusion Criteria:

- Not eligible for colorectal cancer screening for any reason.