title: Testing a culturally appropriate, theory-based intervention to improve colorectal cancer screening among Native Hawaiians.
abstract: BACKGROUND
  We tested an intervention based on social learning theory (SLT) to improve colorectal cancer (CRC) screening among Native Hawaiians, a group with low CRC screening rates.
  
  
  METHODS
  Sixteen Hawaiian civic clubs agreed to randomization. Eight control clubs received a culturally targeted presentation, a free Fecal Occult Blood Test (FOBT), and a reminder call. Eight experimental clubs also received culturally targeted education and free testing; but, in line with SLT, education was delivered by a Native Hawaiian physician and Native Hawaiian CRC survivor, and members received an FOBT demo, were challenged to involve a family member in screening, and were telephoned multiple times to address change-related emotions and barriers.
  
  
  RESULTS
  One hundred twenty-one members age 50 and older from 16 clubs participated. At the club level, screening rates were modestly increased in four experimental clubs and six control clubs. Surprisingly, 64% of participants reported being up to date with CRC screening at baseline. Only 13 individuals (five in experimental arm and eight in the control arm) were screened for the first time through this intervention, increasing the percent screened from 59% to 67% in the experimental group and from 69% to 85% in the control group. Although individuals in the experimental arm were more likely to rate the intervention as culturally appropriate, both arms realized similar and significant gains in CRC knowledge, attitudes, intent, and self-efficacy.
  
  
  CONCLUSIONS
  For Native Hawaiian individuals belonging to a network of civic clubs, an intervention based on SLT delivered by a Native Hawaiian physician and CRC survivor was less effective at further increasing compliance than was a culturally targeted educational session delivered by a non-Hawaiian nurse. That CRC screening compliance was high prior to our intervention suggests that we targeted a very health conscious segment of the Native Hawaiian population. Future work should focus on underserved segments of this indigenous group.
authors.affiliation: Department of Public Health Studies, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA. kbraun@hawaii.edu
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Braun
authors.forename: Megan
authors.initials: M
authors.lastname: Fong
authors.forename: Momi E
authors.initials: ME
authors.lastname: Kaanoi
authors.forename: Martina L
authors.initials: ML
authors.lastname: Kamaka
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Gotay
mesh_terms: D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000517:prevention & control*; D018864:Cultural Diversity; D005260:Female; D005500:Follow-Up Studies; D006254:Hawaii / Q000453:epidemiology; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000193:education* / Q000523:psychology / Q000706:statistics & numerical data; D009780:Occult Blood; D010349:Patient Compliance; D018570:Risk Assessment; D012923:Social Class