SIP16-003 Small Media Interventions to Increase Colorectal Cancer Screening among Chinese Americans

Project Director/Lead Investigator: Tung Nguyen, MD (UCSF PI); Janice Y. Tsoh, PhD (Co-PI); Angela Sun (Subcontract Co-PI); Kent Woo (Subcontract Co-PI);  Marguerita Lightfoot, PhD (UCSF PRC PI)

Through an innovative approach that links community organizations that have cultural and linguistic expertise to healthcare systems that have many Chinese American patients, we will test the effect of combining these small media materials and a mailed patient reminder on the rate of screening for colorectal cancer screening among Chinese Americans in this Small Media Interventions for Limited English Speakers (SMILES) project.

The Specific Aims are to:

Aim 1: Develop English and Chinese (Cantonese and Mandarin) small print and electronic media materials to promote colorectal cancer screening among Chinese Americans;

Aim 2: Compare the efficacy of a combination of mailed patient reminder and small print and electronic media versus usual care among Chinese American patients who are not up-to-date for colorectal cancer screening recruited from 3 healthcare systems in a randomized controlled trial; and

Aim 3: Describe the factors that affect the clinical-community linkages between healthcare systems and community organizations to reduce colorectal cancer screening disparities among Chinese American patients. The team, which consists of bilingual bicultural UCSF researchers and 2 community organizations, the Chinese Community Health Resource Center and NICOS Chinese Health Coalition, has been working together since 2000. Our bilingual colorectal cancer brochures, booklet, flipchart, and videos have been developed rigorously and tested in studies with Chinese Americans.

In Aim 1, we will revise these materials with input from Chinese American patients to create a print booklet and an audio-visual version that can be accessed through a mobile application and website. All print materials will be available in written English, traditional Chinese, and simplified Chinese while all videos will be available in English, Cantonese, and Mandarin.

For Aim 2, we will work with 3 healthcare systems to identify eligible Chinese American patients who are not up-to-date for colorectal cancer screening. They will be randomized into an immediate intervention or control (delayed intervention) arm. The immediate intervention arm will receive 2 mailings separated by 1 month. Each mailing will include a reminder from the primary care physician that the patient is overdue for screening, the booklet, and links to the mobile application and website. Both arms will receive usual care. The main outcome will be receipt of colorectal cancer screening as documented by the electronic health record 6 months later. After the outcome has been collected, the control participants will receive 1 mailing of the same materials.

For Aim 3, we will conduct interviews at the beginning of the project with leaders of the 3 healthcare systems and 2 community organizations to assess expectations about barriers and benefits of clinical-community linkages and ways to address them. We will interview them at the end of the study to identify what worked and did not work. We will interview leaders of other healthcare systems to identify barriers and benefits to participation as well as potential facilitators and solutions. Our strong community-academic team has the environment, resources, and experience to carry out this innovative study using the most methodologically rigorous approach.

Upon study completion, we will utilize our extensive local, regional, and national networks to disseminate the findings of the SMILES project and the small media materials to ensure the greatest possible impact on the reduction of colorectal cancer screening disparities among Chinese Americans.