SIP14-013 Understanding barriers to colorectal cancer screening in South Asians

Project Director/Lead Investigator: Ma Somsouk (UCSF PI); Susan L. Ivey (UCB Project Director/Co-PI); Scarlett Lin Gomez (CPIC Project Director/Co-PI); Marguerita Lightfoot, PhD (UCSF PRC PI) Specific Aim 1: We will conduct a community-based participatory research (CBPR) study to better understand specific patient attitudes and knowledge about cancer; knowledge about colorectal cancer prevention and detection; acceptability of different modalities of colorectal screening (stool-based testing versus endoscopic testing); barriers and facilitators to screening; access and use of health services; and health information seeking behavior. Building upon existing community-academic partnerships, we will:

• Sub-Aim 1: Convene a CAB of patients, family members, and providers from local South Asian communities to provide input and guidance during all phases of the study. All focus group and interview domains and questions will be reviewed by community advisors prior to use.
• Sub-Aim 2: Conduct 8 focus groups (FGs) among South Asian men and women (e.g., Asian Indian, Pakistani, and Bangladeshi groups in the San Francisco Bay area) to understand patient perceptions of cancer, cancer risks, and colorectal screening modalities.
• Sub-Aim 3: Conduct a series of 10 interviews with local community providers and cancer experts to understand contextual and system-level factors in cancer prevention strategies and how they may affect low adherence to CRC screening in South Asian men and women, and to assess relevant interventions, strategies, and messages for improving uptake of colorectal cancer screening among South Asian men and women.

Specific Aim 2: We will apply novel classification techniques to analysis of existing population based data to identify subgroups of South Asians at highest risk of low adherence to CRC screening and late stage diagnosis, for informing targeted community interventions, communication strategies, and messaging to reach South Asian populations. We will:

• Sub-Aim 1: Incorporate guidance from the CAB on key factors to consider in CRC screening. CAB input will inform the design of the analysis of existing population-based data and the interpretation of the results.
• Sub-Aim 2: Use population-based California Cancer Registry data from 1988-2012 to assess prevalence of advanced CRC among South Asian ethnic groups and apply recursive partitioning to identify high-risk populations with high proportions of advanced disease.
• Sub-Aim 3: Use contemporary state-level data (California Health Interview Survey data 2001–2009) to assess trends in CRC screening among South Asians and identify highrisk populations with low adherence to CRC screening guidelines, focusing on insurance coverage, use of other types of preventive services, length of US residence, limited English proficiency, and health literacy measures.

Specific Aim 3: Exploratory: Using findings from Aims 1-2, targeted literature review, and with guidance from the community advisory board, we will identify relevant, ethnic-specific community interventions and communication strategies, including key health messages about CRC screening, tailored to South Asian American target audiences, accounting for differing preferences for type of screening test, primary care versus specialty care access, health literacy levels, and differing language, gender, and cultural needs. We will also assess the feasibility of the interventions and strategies identified, in preparation for next steps of designing tailored interventions, strategies, and messages to better engage South Asian patients in the uptake of colorectal screening modalities.