结直肠癌筛查与华裔美国人：外展工作者宣传及印刷材料的效果
Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials.
作者信息
Nguyen Tung T, Tsoh Janice Y, Woo Kent, Stewart Susan L, Le Gem M, Burke Adam, Gildengorin Ginny, Pasick Rena J, Wang Jun, Chan Elaine, Fung Lei-Chun, Jih Jane, McPhee Stephen J
机构信息
Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
Asian American Research Center on Health, San Francisco, California; Department of Psychiatry, University of California, San Francisco, San Francisco, California.
出版信息
Am J Prev Med. 2017 Mar;52(3):e67-e76. doi: 10.1016/j.amepre.2016.10.003. Epub 2016 Dec 13.
INTRODUCTION
Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans.
DESIGN
Cluster randomized comparative trial.
SETTING/PARTICIPANTS: From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin.
INTERVENTION
Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls.
MAIN OUTCOME MEASURES
Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015.
RESULTS
This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%-88.3%, p<0.0001; Print, 72.3%-79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%-78.1%, p<0.0001; Print, 58.1%-64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date.
CONCLUSIONS
Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants.
TRIAL REGISTRATION
This study is registered at www.clinicaltrials.gov NCT00947206.
引言
美籍华人的结直肠癌（CRC）筛查率较低。目前缺乏基于证据的干预措施来提高该人群的CRC筛查率。本研究旨在比较两种干预措施在提高美籍华人CRC筛查率方面的效果。
设计
整群随机对照试验。
地点/参与者：2010年至2014年，一个社区学术团队在加利福尼亚州旧金山对年龄在50 - 75岁、讲英语、粤语或普通话的美籍华人进行了这项研究。
干预措施
非专业健康工作者（LHW）干预加使用相应语言的宣传册（LHW + 印刷品组）与仅使用宣传册（印刷品组）。LHW + 印刷品组的LHW接受培训，通过两次小组会议和两次电话向参与者传授有关CRC的知识。
主要观察指标
从基线到干预后6个月，自我报告的曾接受CRC筛查情况以及CRC筛查最新情况的变化。2014年至2015年进行了统计分析。
结果
本研究招募了58名LHW，他们又招募了725名参与者。参与者的平均年龄为62.2岁，其中81.1%为女性，99.4%出生在国外。LHW + 印刷品组有9项指标的知识增长显著（p < 0.002），印刷品组有6项。两组在曾接受CRC筛查方面均有增加（LHW + 印刷品组，从73.9%增至88.3%，p < 0.0001；印刷品组，从72.3%增至79.5%，p = 0.0003），在CRC筛查最新情况方面也有增加（LHW + 印刷品组，从60.0%增至78.1%，p < 0.0001；印刷品组，从58.1%增至64.1%，p = 0.0003）。在多变量分析中，LHW + 印刷品组与印刷品组相比，曾进行筛查的干预优势比为1.94（95%CI = 1.34，2.79），筛查最新情况的干预优势比为2.02（95%CI = 1.40，2.90）。
结论
使用相应语言的印刷材料以及LHW推广加印刷材料均提高了美籍华人的CRC筛查率。LHW + 印刷品组的组合比单独使用印刷品更有效。这些发现可为临床医生和政策制定者选择合适的干预措施以提高美籍华人移民的CRC筛查率提供指导。
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