title: The Chinese and Korean American immigrant experience: a mixed-methods examination of facilitators and barriers of colorectal cancer screening.
abstract: Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population.
  
  
  
  This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture.
  
  
  
  Participants who had a regular physician and doctor's recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR) = 3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR = 6.61; 95% CI: 2.63, 16.65, respectively). A doctor's recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR = 4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR = 0.15; 95% CI: 0.03, 0.82 and aOR = 0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the'immigrant life,' who gave precedence to work. Cultural barriers to CRC screening included language (e.g. limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer.
  
  
  
  Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.
authors.affiliation: a Department of Epidemiology and Biostatistics , University of Maryland School of Public Health , College Park , USA.
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Jung
authors.affiliation: b Department of Behavioral and Community Health , University of Maryland School of Public Health , College Park , USA.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Holt
authors.affiliation: a Department of Epidemiology and Biostatistics , University of Maryland School of Public Health , College Park , USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Ng
authors.affiliation: a Department of Epidemiology and Biostatistics , University of Maryland School of Public Health , College Park , USA.
authors.forename: Hwa J
authors.initials: HJ
authors.lastname: Sim
authors.affiliation: a Department of Epidemiology and Biostatistics , University of Maryland School of Public Health , College Park , USA.
authors.forename: Xiaoxiao
authors.initials: X
authors.lastname: Lu
authors.affiliation: b Department of Behavioral and Community Health , University of Maryland School of Public Health , College Park , USA.
authors.forename: Daisy
authors.initials: D
authors.lastname: Le
authors.affiliation: c Division of Population Science, Department of Medical Oncology , Thomas Jefferson University , Philadelphia , USA.
authors.forename: Hee-Soon
authors.initials: HS
authors.lastname: Juon
authors.affiliation: d Epidemiology and Applied Research Branch , Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta , USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: a Department of Epidemiology and Biostatistics , University of Maryland School of Public Health , College Park , USA.
authors.forename: Sunmin
authors.initials: S
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000523:psychology; D002681:China / Q000208:ethnology; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D003144:Communication Barriers; D003467:Cultural Deprivation; D004219:District of Columbia / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006297:Health Services Accessibility; D006801:Humans; D007723:Korea / Q000208:ethnology; D007802:Language; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D036301:Qualitative Research
keywords: Chinese; Colorectal cancer; Koreans; cancer screening; mixed-methods study