Co-Principal Investigator: Rev. Micah Park, Young Sang Church PROJECT SUMMARY Colorectal cancer (CRC) is the second most commonly diagnosed cancer and the third highest cause of mortality in Asian Americans. Despite a decline in the incidence of CRC in the general population, its incidence in the Korean community is rising. Korean men ranked the second highest in incidence and mortality from CRC compared with those of non-Hispanic White men. Among Korean women, CRC is the second most commonly diagnosed cancer. Although the efficacy of routine and timely screening has been demonstrated as a viable preventive measure against the development of the disease, various studies have shown that CRC screening rates among Koreans are extremely low for every type of CRC screening, and when screening is obtained, it is more likely to reveal a late stage of the disease and poor prognosis for 5-year survival. Our studies ofthe Korean community in PA and NJ indicated consistently low rates of CRC screening (13% to 17%, in Koreans vs 52% in general populations) and multiple barriers to health care. About 80% Koreans we serve are medically underserved and low income, lack of knowledge about CRC risks, screening benefits and health system, and have limited or no access to culturally and linguistically appropriate health care. There is a lack of CRC screening intervention program tailored to the needs of Koreans. The proposed project will address this gap by evaluating the effectiveness of a multifaceted and culturally appropriate Korean church-based intervention using community-based participatory research (CBPR) approach to significantly improve CRC screening among medically underserved members of Korean churches (30 church sites) in PA and NJ. The project will be built on an established long-standing infrastructure of community-academic-clinical partnership that has collaborated successfully on several CBPR guided projects in Korean and other Asian communities, as well as a pilot CBPR CRC intervention among Koreans. The overall goal of the study is to maintain and ensure sustainable partnerships using CBPR approach to increase CRC screening by reducing healthcare access barriers for underserved Koreans. Specifically, the study aims to examine whether a culturally appropriate CBPR CRC intervention is more effective in increasing screening, knowledge of, perceived risks of and susceptibility to CRC and benefits of screening, as well as reducing health system barriers to screening. CBPR principles and logic model will be used to guide all phases of the study in developing and implementing project plans, procedures, intervention, evaluation and dissemination. The study design is a 2-arm group randomized trial with baseline and post-intervention assessment and a 12-month follow-up. A total of 30 Korean churches will be randomized to either an immediate intervention or control group (general cancer education plus delayed intervention). The proposed intervention, guided by an integrative framework of Health Belief Model and Social Cognitive Theory, addresses both individual and healthcare system barriers through multifaceted innovative approaches. Key components include: (1) group education by trained bilingual community health educators and church health workers;(2) patient navigation by Community Health Educators (CHEs) and Community Health Workers (CHWs);and (3) engaging community bilingual physicians in CRC screening and referral. The proposed study is expected to yield important and new data on the inten/ention effects. If this CBPR CRC intervention proves effective, it can be used as a model program that has potential transportability to and sustainability in Korean and other Asian communities nationally, hence make a substantial contribution toward reducing health disparities.
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