Promoting culturally appropriate colorectal cancer screening through a health educator

Colorectal cancer (CRC) screening rates can be significantly improved using a dedicated health educator empowered with culturally appropriate educational tools, according to a new study.

Published in the September 1, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, a randomized, controlled trial found low income Chinese-speaking patients were six-times more likely to be screened for CRC when a clinic-based, multilingual health educator provided culturally and linguistically appropriate counseling, educational materials, and screening test instructions.

More than 148,000 men and women will be diagnosed with CRC in 2006, according to the American Cancer Society, and more than half will present with advanced disease with poor prognoses. Because patients with localized CRC have excellent prognoses, early detection of the disease through screening is critical. To reduce CRC mortality, screening tools, like fecal occult blood testing (FOBT), flexible sigmoidoscopy, and colonoscopy are currently recommended for average risk individuals who are 50 years or older. Still, screening rates are disappointingly low, with just over half of adults 50 and over reporting having had a recent test.

Until a few decades ago, CRC was predominantly a Western disease afflicting Caucasians. Studies of immigrants from low-incidence countries to the U.S. show that CRC incidence increases within one generation. In Hawaii and Los Angeles, CRC incidence rates among one Asian and Pacific Islander group, the Japanese Americans, are among the highest in the world. Moreover, the Asian Pacific Islander population is at risk for presenting with more advanced diseases. One study has shown that foreign-born Asians and Pacific Islanders in the U.S. are particularly more likely to present with metastatic disease.

Led by Shin-Ping Tu, M.D., M.P.H. of the Harborview Medical Center/University of Washington and the Fred Hutchinson Cancer Research Center in Seattle, researchers investigated the effectiveness of a clinic-based, multilingual intervention to increase CRC screening by FOBT within six months among low income, poorly acculturated Chinese in the U.S. In this randomized control clinical trial, one group received standard of care and the other group received counseling from a trilingual and bicultural health educator and were given multilingual educational materials (i.e., video, pamphlets), FOBT instructions, and three FOBT cards.

Within the six months of the intervention, seven out of ten people (69.5 percent) in the intervention arm had completed FOBT screening compared to fewer than three out of ten (27.6 percent) in the control arm.

"Our results confirm the notable effectiveness of a multi-component, culturally appropriate health education program to promote FOBT screening within an ethnic minority group," the authors write. In the context of interventions for other at-risk populations, "the large effect of our intervention suggests the remarkable impact of culturally appropriate health education among populations with limited health information," they conclude.

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