title: Promoting culturally appropriate colorectal cancer screening through a health educator: a randomized controlled trial.
abstract: BACKGROUND
  Colorectal cancer (CRC) is a leading cause of cancer mortality in the US. Surveys reveal low CRC screening levels among Asians in the US, including Chinese Americans.
  
  
  METHODS
  A randomized controlled trial was conducted with Chinese patients to evaluate a clinic-based, culturally and linguistically appropriate intervention promoting fecal occult blood test (FOBT) screening. The multifaceted intervention included a trilingual and bicultural health educator, bilingual materials (a video, a motivational pamphlet, an informational pamphlet, and FOBT instructions), and three FOBT cards. Patients in the control arm received usual care. Our primary outcome measure was FOBT screening within 6 months after randomization. The proportion of FOBT completion in the intervention and control arms was compared by using a chi-square test, and logistic regression analysis was performed to adjust for the effects of sociodemographic variables and prior screening history. Potential effect modifications were also tested by using logistic regression models.
  
  
  RESULTS
  Our intervention had a strong effect on FOBT completion (intervention group, 69.5%; control group, 27.6%), and the adjusted odds of FOBT slightly increased to over 6-fold greater in the intervention arm compared with the control arm. No effect modification by age, gender, language, insurance, or prior FOBT was found.
  
  
  CONCLUSIONS
  The authors' multifaceted, culturally appropriate intervention significantly increased FOBT screening in a group of low-income and less-acculturated minority patients. Given the large effect size, future research should determine the effective core component(s) that can increase CRC screening in both the general and minority populations.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington 98104, USA. shinping@u.washington.edu
authors.forename: Shin-Ping
authors.initials: SP
authors.lastname: Tu
authors.forename: Vicky
authors.initials: V
authors.lastname: Taylor
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Alan
authors.initials: A
authors.lastname: Chun
authors.forename: Mei-Po
authors.initials: MP
authors.lastname: Yip
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Acorda
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.forename: Roshan
authors.initials: R
authors.lastname: Bastani
mesh_terms: D000368:Aged; D001213:Asian; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D018864:Cultural Diversity; D005260:Female; D006266:Health Education; D040441:Health Educators; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008913:Minority Groups; D019303:Multilingualism; D015999:Multivariate Analysis; D009780:Occult Blood; D017063:Outcome Assessment, Health Care; D012923:Social Class