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Lay health educators increase CRC screening in Southeast Asian immigrants
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Americans of Hmong descent were more likely to undergo screening for colorectal cancer when given information by trained bilingual/bicultural Hmong lay health educators, according to the results of a cluster randomized controlled trial recently published in Cancer.
“Hmong Americans in the age group for colorectal cancer screening are especially vulnerable because of low levels of education and limited literacy, even in the Hmong written language,” Elisa K. Tong, MD, associate professor of internal medicine at University of California at Davis, Sacramento, said in a press release. “Added to that are the cultural barriers that can come with receiving Western medical care. We asked, ‘Can Hmong community members help their friends and family learn about colorectal cancer screening so that they will get screened and be up-to-date?’”
Elisa K. Tong
As Sacramento has the third largest Hmong population in the U.S., Tong and colleagues partnered with the Hmong Women’s Heritage Association to recruit 29 Hmong lay health educators who then helped to recruit 329 foreign-born Hmong Americans (mean age, 60.4 years) living in the city. Most of the participants lacked a formal education, English language fluency and employment, but most were insured and had regular health care access.
From March 2012 through August 2015, the researchers randomly assigned both the lay health educators and participants to an intervention group — in which lay health educators received culturally and linguistically appropriate training to deliver colorectal cancer education over 3 months — and a control group, in which nutrition and physical activity education was delivered by an untrained health educator.
After 6 months, the intervention group showed significantly greater increases in awareness about colorectal cancer screening methods compared with the control group. Those in the intervention group also had higher increases in ever-screening (72.1% to 83.2% in the intervention group vs. 72% to 75% in controls; P = .068) and being up-to-date with screening (44.1% to 57.1% vs. 43.5% to 43.5%; P < .0001).
Multivariable regression analyses showed the intervention group had a higher increase in reporting having ever been screened (adjusted OR = 1.73; 95% CI, 1.07-2.79) and being up-to-date with screening (aOR = 1.71; 95% CI, 1.26-2.32).
Participants who were insured were more than four times more likely to be screened, and a higher colorectal cancer knowledge score mediated the intervention effect for screening outcomes.
“The study helped resolve a lot of common beliefs and opened doors to introducing cancer prevention education to the Hmong community,” Penny Lo, BS, project coordinator with the Hmong Women’s Heritage Association and study co-author, said in the press release. “Lay health educators have access to the community because of family or church relations that even nonprofit organizations can’t normally reach.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
Photo credit: UC Davis Health System
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