Preventing Chronic Disease | Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study - CDC
Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study
Jun Wang, PhD; Adam Burke, PhD; Janice Y. Tsoh, PhD; Gem M. Le, PhD; Susan Stewart, PhD; Ginny Gildengorin, PhD; Ching Wong, BS; Elaine Chow, BA; Kent Woo, MS; Tung T. Nguyen, MD
Suggested citation for this article: Wang J, Burke A, Tsoh JY, Le GM, Stewart S, Gildengorin G, et al. Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study. Prev Chronic Dis 2014;11:140341. DOI: http://dx.doi.org/10.5888/pcd11.140341
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Abstract
Introduction
Although colorectal cancer (CRC) screening is effective in preventing colon cancer, it remains underused by Asian Americans. Because Chinese Americans often use traditional Chinese medicine (TCM), we conducted a pilot study to explore the feasibility and acceptability of having TCM providers deliver education about CRC screening.
Although colorectal cancer (CRC) screening is effective in preventing colon cancer, it remains underused by Asian Americans. Because Chinese Americans often use traditional Chinese medicine (TCM), we conducted a pilot study to explore the feasibility and acceptability of having TCM providers deliver education about CRC screening.
Methods
Four TCM providers (2 herbalists and 2 acupuncturists) were trained to deliver small-group educational sessions to promote CRC screening. Each provider recruited 15 participants aged 50 to 75. Participants completed a baseline survey on CRC-related knowledge, attitudes, and behaviors and then attended one 2-hour educational session delivered by the providers in Cantonese or Mandarin. Three months later, participants completed a postintervention survey.
Four TCM providers (2 herbalists and 2 acupuncturists) were trained to deliver small-group educational sessions to promote CRC screening. Each provider recruited 15 participants aged 50 to 75. Participants completed a baseline survey on CRC-related knowledge, attitudes, and behaviors and then attended one 2-hour educational session delivered by the providers in Cantonese or Mandarin. Three months later, participants completed a postintervention survey.
Results
Sixty participants were recruited from the San Francisco Chinatown neighborhood. The average age was 62.4 years. Most participants had limited English proficiency (96.7%), annual household income less than $20,000 per year (60%), and low educational attainment (65.1% < high school education). At postintervention (n = 57), significant increases were found in having heard of CRC (from 52.6% to 79.0%, P < .001) and colon polyps (from 64.9% to 84.2%, P < .001). Knowledge regarding screening frequency recommendations also increased significantly. The rate of ever having received any CRC screening test increased from 71.9% to 82.5% (P <.001). The rate of up-to-date screening increased from 70.2% to 79.0% (P = .04).
Sixty participants were recruited from the San Francisco Chinatown neighborhood. The average age was 62.4 years. Most participants had limited English proficiency (96.7%), annual household income less than $20,000 per year (60%), and low educational attainment (65.1% < high school education). At postintervention (n = 57), significant increases were found in having heard of CRC (from 52.6% to 79.0%, P < .001) and colon polyps (from 64.9% to 84.2%, P < .001). Knowledge regarding screening frequency recommendations also increased significantly. The rate of ever having received any CRC screening test increased from 71.9% to 82.5% (P <.001). The rate of up-to-date screening increased from 70.2% to 79.0% (P = .04).
Conclusion
The findings suggest that TCM providers can be trained to deliver culturally and linguistically appropriate outreach on CRC screening within their community. Participants reached by TCM providers increased CRC knowledge and self-reported CRC screening.
The findings suggest that TCM providers can be trained to deliver culturally and linguistically appropriate outreach on CRC screening within their community. Participants reached by TCM providers increased CRC knowledge and self-reported CRC screening.
Introduction
Colorectal cancer (CRC) is the third most commonly diagnosed cancer among both Chinese American men and women (1). CRC screening is a cost-effective approach to reduce CRC mortality, but CRC screening rates remain low among Asian Americans (2). Analysis of the 2007 California Health Interview Survey (CHIS) revealed that Asian Americans with low health literacy and limited English proficiency were most vulnerable to CRC screening disparities (3). A possible barrier to CRC screening among Chinese Americans may be lack of awareness (4). Other studies of Chinese immigrants have noted a lack of understanding of CRC screening as a preventive measure, as well as challenges with language, transportation, access to health care, limited social support for use of screening services, and lack of health insurance (5–7). A review of 30 culturally appropriate cancer screening intervention studies found that community-based and lay health worker strategies were effective in improving cancer screening rates among Asian Americans. Commonly used communication channels were churches and Asian grocery stores (8).
Traditional Chinese medicine (TCM) providers may provide another useful community-based channel to convey culturally appropriate information about CRC screening. Use of TCM, such as acupuncture and herbal medicine, is high among Chinese Americans. The 2002 National Health Interview Survey (NHIS) found that Asian American women were significantly more likely to use acupuncture compared with other racial/ethnic groups (9). Other national surveys have also found that use of acupuncture, herbs, and related services is high among Asian Americans (10–12). Traditional medicine providers have health message credibility, are readily accessible, and embody the cultural and linguistic characteristics of the communities they serve. As such, they have the potential to be an effective channel for health promotion. International studies have shown the practical value of integrating traditional healers into community health messaging, including studies finding positive outcomes in HIV care, oral rehydration therapy, water treatment, sanitation and hygiene, nutrition education, and birthing practices (13–15). Two studies conducted in the United States found that traditional Chinese medicine providers are interested in participating in community-based preventive education programs (16,17).
To date, no published studies have tested a community-based cancer screening intervention using traditional healers in the United States. To fill this gap, we conducted a pilot study during 2008–2013 to explore the feasibility and acceptability of TCM providers offering education in CRC prevention in the Chinatown neighborhood of San Francisco. The hypothesis was that educational sessions delivered by TCM providers would increase participants’ CRC screening knowledge and screening rates.
Acknowledgments
This study was supported by the National Cancer Institute (NCI) Grant R01CA138778. Additional support was provided by NCI’s Center to Reduce Cancer Health Disparities through Grant 1U54153499. The content is solely the responsibility of the authors and does not reflect the official views of NCI.
Author Information
Corresponding Author: Jun Wang, PhD, 1600 Holloway Ave, Bldg HSS 327, San Francisco State University, San Francisco, CA 94132-4161. Telephone: 415–405–2147. E-mail: wangjun@sfsu.edu. Dr Wang is also affiliated with the Asian American Research Center on Health, San Francisco, California.
Author Affiliations: Adam Burke, San Francisco State University, Asian American Research Center on Health, San Francisco, California; Janice Y. Tsoh, University of California and Asian American Research Center on Health, San Francisco, California; Gem M. Le, Ginny Gildengorin, Ching Wong, University of California, San Francisco, California; Susan Stewart, University of California, Davis, California; Elaine Chow, NICOS Chinese Health Coalition, San Francisco, California; Kent Woo, NICOS Chinese Health Coalition and Asian American Research Center on Health, San Francisco, California; Tung T. Nguyen, University of California and Asian American Research Center on Health, San Francisco, California.
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