Premium
Lay health educators increase colorectal cancer screening among Hmong Americans: A cluster randomized controlled trial
Author(s) -
Tong Elisa K.,
Nguyen Tung T.,
Lo Penny,
Stewart Susan L.,
Gildengorin Ginny L.,
Tsoh Janice Y.,
Jo Angela M.,
KagawaSinger Marjorie L.,
Sy Angela U.,
Cuaresma Charlene,
Lam Hy T.,
Wong Ching,
Tran Mi T.,
Chen Moon S.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30265
Subject(s) - medicine , randomized controlled trial , odds ratio , confidence interval , cancer screening , cluster randomised controlled trial , socioeconomic status , health equity , health literacy , gerontology , demography , family medicine , health care , public health , cancer , population , environmental health , nursing , sociology , economics , economic growth
BACKGROUND Asian Americans have lower colorectal cancer (CRC) screening rates than non‐Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans. METHODS A cluster randomized controlled trial was conducted among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by an LHE. The control group received education regarding nutrition and physical activity delivered by a health educator. The outcomes were changes in self‐reported ever‐screening and up‐to‐date CRC screening after 6 months. RESULTS All 329 participants were foreign‐born with mostly no formal education, limited English proficiency, and no employment. The majority of the participants were insured and had a regular source of health care. The intervention group experienced greater changes after the intervention than the control group for ever‐screening ( P = .068) and being up‐to‐date with screening ( P <.0001). In multivariable regression analyses, the intervention group demonstrated a greater increase than the control group in reporting ever‐screening (adjusted odds ratio, 1.73; 95% confidence interval, 1.07‐2.79) and being up‐to‐date with screening (adjusted odds ratio, 1.71; 95% confidence interval, 1.26‐2.32). Individuals who had health insurance were found to have >4 times the odds of receiving screening, both ever‐screening and up‐to‐date screening. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. CONCLUSIONS A culturally and linguistically appropriate educational intervention delivered by trained LHEs was found to increase CRC screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Cancer 2017;98–106. © 2016 American Cancer Society.