Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials

Published:December 13, 2016DOI:


      Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans.


      Cluster randomized comparative trial.


      From 2010 to 2014, a community–academic team conducted this study in San Francisco, CA with Chinese Americans aged 50–75 years who spoke English, Cantonese, or Mandarin.


      Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls.

      Main outcome measures

      Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015.


      This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%–88.3%, p<0.0001; Print, 72.3%–79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%–78.1%, p<0.0001; Print, 58.1%–64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date.


      Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants.

      Trial registration

      This study is registered at NCT00947206.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hoeffel E.M.
        • Rastogi S.
        • Kim M.O.
        • Shahid H.T.
        The Asian Population: 2010.
        U.S. Census Bureau, Washington, DC2012
      1. U.S. Census Bureau. 2011-2013 American Community Survey 3-year estimates. Published 2014. Accessed November 15, 2015.

        • Miller B.A.
        • Chu K.C.
        • Hankey B.F.
        • Ries L.A.
        Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S.
        Cancer Causes Control. 2008; 19: 227-256
        • Le Marchand L.
        • Wilkens L.R.
        • Kolonel L.N.
        • Hankin J.H.
        • Lyu L.C.
        Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer.
        Cancer Res. 1997; 57: 4787-4794
        • Vernon S.W.
        Participation in colorectal cancer screening: a review.
        J Natl Cancer Inst. 1997; 89: 1406-1422
        • Selby J.V.
        • Friedman G.D.
        • Quesenberry C.P.
        • Weiss N.S.
        A case-control study of screening sigmoidoscopy and mortality from colorectal cancer.
        N Engl J Med. 1992; 326: 653-657
        • Mandel J.S.
        • Bond J.H.
        • Church T.R.
        • et al.
        Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study.
        N Engl J Med. 1993; 328: 1365-1371
        • Hardcastle J.D.
        • Chamberlain J.O.
        • Robinson M.H.
        • et al.
        Randomised controlled trial of faecal-occult-blood screening for colorectal cancer.
        Lancet. 1996; 348: 1472-1477
        • Maciosek M.V.
        • Coffield A.B.
        • Edwards N.M.
        • Flottemesch T.J.
        • Goodman M.J.
        • Solberg L.I.
        Priorities among effective clinical preventive services: results of a systematic review and analysis.
        Am J Prev Med. 2006; 31: 52-61
        • Screening for colorectal cancer: U.S
        Preventive Services Task Force recommendation.
        Ann Intern Med. 2008; 149: I44
        • Wong S.T.
        • Gildengorin G.
        • Nguyen T.
        • Mock J.
        Disparities in colorectal cancer screening rates among Asian Americans and non-Latino whites.
        Cancer. 2005; 104: 2940-2947
        • Homayoon B.
        • Shahidi N.C.
        • Cheung W.Y.
        Impact of asian ethnicity on colorectal cancer screening: a population-based analysis.
        Am J Clin Oncol. 2013; 36: 167-173
        • Tu S.P.
        • Taylor V.
        • Yasui Y.
        • et al.
        Promoting culturally appropriate colorectal cancer screening through a health educator: a randomized controlled trial.
        Cancer. 2006; 107: 959-966
        • Inadomi J.M.
        • Vijan S.
        • Janz N.K.
        • et al.
        Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies.
        Arch Intern Med. 2012; 172: 575-582
        • Walsh J.M.
        • Salazar R.
        • Nguyen T.T.
        • et al.
        Healthy colon, healthy life: a novel colorectal cancer screening intervention.
        Am J Prev Med. 2010; 39: 1-14
        • Maxwell A.E.
        • Bastani R.
        • Danao L.L.
        • Antonio C.
        • Garcia G.M.
        • Crespi C.M.
        Results of a community-based randomized trial to increase colorectal cancer screening among Filipino Americans.
        Am J Public Health. 2010; 100: 2228-2234
        • Nguyen B.H.
        • Stewart S.L.
        • Nguyen T.T.
        • Bui-Tong N.
        • McPhee S.J.
        Effectiveness of lay health worker outreach in reducing disparities in colorectal cancer screening in Vietnamese Americans.
        Am J Public Health. 2015; 105: 2083-2089
        • Potter M.B.
        • Walsh J.M.
        • Yu T.M.
        • Gildengorin G.
        • Green L.W.
        • McPhee S.J.
        The effectiveness of the FLU-FOBT program in primary care a randomized trial.
        Am J Prev Med. 2011; 41: 9-16
        • Potter M.B.
        • Yu T.M.
        • Gildengorin G.
        • et al.
        Adaptation of the FLU-FOBT Program for a primary care clinic serving a low-income Chinese American community: new evidence of effectiveness.
        J Health Care Poor Underserved. 2011; 22: 284-295
        • Tu S.P.
        • Yip M.P.
        • Chun A.
        • Choe J.
        • Bastani R.
        • Taylor V.
        Development of intervention materials for individuals with limited English proficiency: lessons learned from “Colorectal Cancer Screening in Chinese Americans”.
        Med Care. 2008; 46: S51-S61
        • WHO
        Community Health Workers: Working Document for the WHO Study Group.
        WHO, Geneva, Switzerland1987
        • Swider S.M.
        Outcome effectiveness of community health workers: an integrative literature review.
        Public Health Nurs. 2002; 19: 11-20
        • Mock J.
        • McPhee S.J.
        • Nguyen T.
        • et al.
        Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women.
        Am J Public Health. 2007; 97: 1693-1700
        • Nguyen T.T.
        • Le G.
        • Nguyen T.
        • et al.
        Breast cancer screening among Vietnamese Americans: a randomized controlled trial of lay health worker outreach.
        Am J Prev Med. 2009; 37: 306-313
        • Engelstad L.P.
        • Stewart S.
        • Otero-Sabogal R.
        • Leung M.S.
        • Davis P.I.
        • Pasick R.J.
        The effectiveness of a community outreach intervention to improve follow-up among underserved women at highest risk for cervical cancer.
        Prev Med. 2005; 41: 741-748
        • Nguyen T.T.
        • Love M.B.
        • Liang C.
        • et al.
        A pilot study of lay health worker outreach and colorectal cancer screening among Chinese Americans.
        J Cancer Educ. 2010; 25: 405-412
        • Prochaska J.O.
        A Theorectical Model of Behavior Change: Learning From Mistakes With Majority Populations.
        NIH. 1992;
        • Prochaska J.O.
        • Velicer W.F.
        The transtheoretical model of health behavior change.
        Am J Health Promot. 1997; 12: 38-48
        • Nguyen B.H.
        • McPhee S.J.
        • Stewart S.L.
        • Doan H.T.
        Effectiveness of a controlled trial to promote colorectal cancer screening in Vietnamese Americans.
        Am J Public Health. 2010; 100: 870-876
        • Nguyen T.T.
        • McPhee S.J.
        • Gildengorin G.
        • et al.
        Papanicolaou testing among Vietnamese Americans: results of a multifaceted intervention.
        Am J Prev Med. 2006; 31: 1-9
        • Baier M.
        • Calonge N.
        • Cutter G.
        • et al.
        Validity of self-reported colorectal cancer screening behavior.
        Cancer Epidemiol Biomarkers Prev. 2000; 9: 229-232
        • Khoja S.
        • McGregor S.E.
        • Hilsden R.J.
        Validation of self-reported history of colorectal cancer screening.
        Can Fam Physician. 2007; 53: 1192-1197
        • Jones R.M.
        • Mongin S.J.
        • Lazovich D.
        • Church T.R.
        • Yeazel M.W.
        Validity of four self-reported colorectal cancer screening modalities in a general population: differences over time and by intervention assignment.
        Cancer Epidemiol Biomarkers Prev. 2008; 17: 777-784
        • Liss D.T.
        • Baker D.W.
        Understanding current racial/ethnic disparities in colorectal cancer screening in the United States: the contribution of socioeconomic status and access to care.
        Am J Prev Med. 2014; 46: 228-236
        • Nguyen T.T.
        • McPhee S.J.
        • Bui-Tong N.
        • et al.
        Community-based participatory research increases cervical cancer screening among Vietnamese-Americans.
        J Health Care Poor Underserved. 2006; 17: 31-54