and Abstract Colorectal cancer (CRC) screening saves lives but CRC screening rates remain low among Chinese Americans, the most populous Asian American group. Little is known about how to conduct effective and culturally appropriate community-based health promotion in this ethnic group. Lay Health Worker Outreach (LHWO) is an effective modality to promote some healthy behaviors in some communities, but much remains unknown about this approach and no prior work has been done with Chinese Americans. 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 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 and older with a pilot component to evaluate the role of Traditional Chinese Medicine (TCM) healers as health educators. We will refine and implement a culturally and linguistically appropriate community outreach program based on LHWs to promote CRC screening among Chinese Americans age 50 to 75. The developmental work will be based on a prior successful pilot project, focus groups, and key informant inputs. These materials will be used in the first aim, which is to evaluate the effectiveness of LHWO on receipt of CRC screening among Chinese Americans in a group randomized trial using LHWs to deliver CRC education (intervention) compared to a CRC brochure (comparison) in a sample of Chinese Americans age 50 to 75, living in San Francisco, and recruited through social networks of LHWs. Twenty-six LHWs each will 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. 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.
The second aim i s to examine the processes through which LHWs work as health educators in this community.
This aim will be achieved by using mixed methods including surveys (of the LHWs and participants), focus groups (of the LHWs and participants), and observations conducted during LHW educational sessions.
The third aim i s to examine and expand the current paradigm of "lay" health education in Asian communities by exploring the roles that TCM practitioners such as herbalists and acupuncturists may play in delivering health education messages focused on a biomedical model of cancer prevention.
This aim will be implemented and evaluated using the methodologies employed in the developmental, implementation, and evaluation process in the prior 2 aims. The proposal also will explore ways through which LHWO can be disseminated and community capacity can be sustained. The findings of this project will greatly expand understanding about effective and culturally appropriate cancer health promotion among ethnic minority communities.

Public Health Relevance

This proposed project seeks to expand understanding of what constitutes a lay health worker, how those characteristics determine the effectiveness of lay health workers as health educators on colorectal cancer screening, and the relationship of those characteristics to Chinese American community and culture. Using a variety of methods and a community-oriented approach, the project will evaluate the effectiveness of lay health workers in promoting colorectal cancer screening among Chinese Americans age 50 to 75 in a randomized controlled study. The project also includes a pilot study to evaluate the role of Traditional Chinese Medicine (TCM) healers as health educators. The findings of this project will greatly expand understanding about effective and culturally appropriate cancer health promotion among ethnic minority communities.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA138778-04
Application #
8307961
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Breslau, Erica S
Project Start
2009-09-01
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
4
Fiscal Year
2012
Total Cost
$515,037
Indirect Cost
$114,155
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143