Reducing Health Disparities in Maryland Along the National Capital Border

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DESCRIPTION (provided by applicant): Cancer is the leading cause of death among Asian American and Pacific Islanders (AAPIs), and mortality from colorectal cancer (CRC) is ranked as the third most common in cancer deaths among AAPIs. However, CRC screening rates among Asian Americans are significantly lower than in other racial/ethnic groups. Considering that CRC screening reduces mortality by up to 79%, it is not surprising that CRC mortality has not been reduced among Chinese- and Korean Americans during last decade unlike in other racial/ethnic groups where a decreasing trend has been observed. There is a strong need to understand CRC screening behaviors particularly regarding barriers to and facilitators of CRC screening and strategies to increase CRC screening among Chinese- and Korean Americans. Few studies have examined the factors associated with CRC screening among Chinese- and Korean Americans. The majority of these studies collected data using closed-ended surveys. Therefore, more in-depth data on the factors underlying screening decisions have been limited. To address this notable gap in the literature, we propose to conduct a study to better understand the barriers to and facilitators of CRC screening, using a mixed methods approach. Potential factors to be explored will be based on concepts from the Health Belief Model and the Social Ecological Model. Specifically, we propose the following two aims: First, gain a preliminary understanding of barriers to and facilitators of CRC screening among Chinese- and Korean Americans age 50 and older by conducting 20 key informant interviews. Based on these findings, we will then finalize or inform the draft of our focus group guide. Second, provide understanding of barriers to and facilitators of CRC screening among this population by: conducting 12 focus groups with 120 participants that are segmented by Chinese- and Korean American ethnicity; conducting surveys with focus group participants to obtain quantitative data; and using a triangulation approach to converge results from the key informant interviews, focus groups, and survey responses to explore major findings. Considering the sustained CRC mortality and low CRC screening rates in this understudied Chinese- and Korean American population, findings from this two-stage mixed methods study will help enhance the understanding of the barriers to and facilitators of CRC screening. Moreover, the findings will inform the development of future interventions that incorporate culturally and linguistically appropriate strategies into communication messages, community outreach and education, and environmental and system to increase screening rates within the Asian American population. Furthermore, the proposed study will address the overarching Healthy People 2020 objective to reduce health disparities, as well as to reduce the number of new CRC cases and deaths.