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Barriers and Facilitators to Colorectal Cancer Screening in Vietnamese Americans: A Qualitative Analysis

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Abstract

Vietnamese Americans are the fourth largest Asian ethnic group in the USA. Colorectal cancer (CRC) ranks as one of the most common cancers in Vietnamese Americans. However, CRC screening rates remain low among Vietnamese Americans, with 40 % of women and 60 % of men reporting never having a sigmoidoscopy, colonoscopy, or fecal occult blood test (FOBT). We partnered with a Federally Qualified Health Center (FQHC) in Seattle, WA, to conduct focus groups as part of a process evaluation. Using interpreters, we recruited and conducted three focus groups comprised of six women screened for CRC, six women not screened for CRC, and seven men screened for CRC, which made up a total of 19 FQHC patients of Vietnamese descent between 50 and 79 years old. Three team members analyzed transcripts using open coding and axial coding. Major themes were categorized into barriers and facilitators to CRC screening. Barriers include lack of health problems, having comorbidities, challenges with medical terminology, and concerns with the colonoscopy. Participants singled out the risk of perforation as a fear they have toward colonoscopy procedures. Facilitators include knowledge about CRC and CRC screening, access to sources of information and social networks, and physician recommendation. Our focus groups elicited information that adds to the literature and has not been previously captured through published surveys. Findings from this study can be used to develop more culturally appropriate CRC screening interventions and improve upon existing CRC screening programs for the Vietnamese American population.

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References

  1. American Cancer Society (2011). Cancer facts and figures. http://www.cancer.org/Research/CancerFactsFigures/index. Accessed 23 Sept 2011

  2. Bernard HR, Ryan GW (2010) Analyzing qualitative data: systematic approaches. Sage Publications, Thousand Oaks

    Google Scholar 

  3. Berster JM, Goke B (2008) Type 2 diabetes mellitus as risk factor for colorectal cancer. Arch Physiol Biochem 114(1):84–98. doi:10.1080/13813450802008455

    Article  CAS  PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention (2012) Colorectal (colon) cancer. http://www.cdc.gov/cancer/colorectal/what_cdc_is_doing/success/ca2.htm. Accessed

  5. Corbin J, Strauss A (2008) Basics of qualitative research, 3 Aufl. Sage Publications, Thousand Oaks

    Google Scholar 

  6. Denberg TD, Melhado TV, Coombes JM, Beaty BL, Berman K, Byers TE, Marcus AC, Steiner JF, Ahnen DJ (2005) Predictors of nonadherence to screening colonoscopy. J Gen Intern Med 20(11):989–995. doi:10.1111/j.1525-1497.2005.00164.x

    Article  PubMed Central  PubMed  Google Scholar 

  7. Deng L, Gui Z, Zhao L, Wang J, Shen L (2012) Diabetes mellitus and the incidence of colorectal cancer: an updated systematic review and meta-analysis. Dig Dis Sci 57(6):1576–1585. doi:10.1007/s10620-012-2055-1

    Article  CAS  PubMed  Google Scholar 

  8. Fenton JJ, Tancredi DJ, Green P, Franks P, Baldwin LM (2009) Persistent racial and ethnic disparities in up-to-date colorectal cancer testing in medicare enrollees. J Am Geriatr Soc 57(3):412–418

    Article  PubMed  Google Scholar 

  9. Garman KS, Jeffreys A, Coffman C, Fisher DA (2006) Colorectal cancer screening, comorbidity, and follow-up in elderly patients. Am J Med Sci 332(4):159–163

    Article  PubMed  Google Scholar 

  10. Giddings BH, Kwong SL, Parikh-Patel A, Bates JH, Snipes KP (2012) Going against the tide: increasing incidence of colorectal cancer among Koreans, Filipinos, and South Asians in California, 1988–2007. Cancer Causes Control 23(5):691–702. doi:10.1007/s10552-012-9937-6

    Article  PubMed  Google Scholar 

  11. Glasgow RE, Vogt TM, Boles SM (1999) Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 89(9):1322–1327

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Gomez SL, Noone AM, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L, Morris C et al (2013) Cancer incidence trends among Asian American populations in the United States, 1990 to 2008. J Natl Cancer Inst. doi:10.1093/jnci/djt157

    Google Scholar 

  13. Goodman MJ, Ogdie A, Kanamori MJ, Canar J, O’Malley AS (2006) Barriers and facilitators of colorectal cancer screening among Mid-Atlantic Latinos: focus group findings. Ethn Dis 16(1):255–261

    PubMed  Google Scholar 

  14. Green AR, Peters-Lewis A, Percac-Lima S, Betancourt JR, Richter JM, Janairo MP, Gamba GB, Atlas SJ (2008) Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. J Gen Intern Med 23(6):834–840. doi:10.1007/s11606-008-0572-6

    Article  PubMed Central  PubMed  Google Scholar 

  15. Guessous I, Dash C, Lapin P, Doroshenk M, Smith RA, Klabunde CN (2010) Colorectal cancer screening barriers and facilitators in older persons. Prev Med 50(1–2):3–10. doi:10.1016/j.ypmed.2009.12.005

    Article  PubMed  Google Scholar 

  16. Hassan C, Fuccio L, Bruno M, Pagano N, Spada C, Carrara S, Giordanino C et al (2012) A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 10(5):501–506. doi:10.1016/j.cgh.2011.12.037

    Article  PubMed  Google Scholar 

  17. Ho D (2006) The focus group interview: rising to the challenge in qualitative research methodology. Aust Rev Appl Linguist 29(1):05.01–05.19

    Article  Google Scholar 

  18. Hoeffel EM, Rastogi S, Kim MO, Shahid H (2012) The Asian population: 2010. In: 2010 Census Briefs

  19. Hou SI, Sealy DA, Kabiru CW (2011) Closing the disparity gap: cancer screening interventions among Asians—a systematic literature review. Asian Pac J Cancer Prev 12(11):3133–3139

    PubMed  Google Scholar 

  20. Inadomi JM, Vijan S, Janz NK, Fagerlin A, Thomas JP, Lin YV, Munoz R et al (2012) Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med 172(7):575–582. doi:10.1001/archinternmed.2012.332

    Article  PubMed Central  PubMed  Google Scholar 

  21. Jilcott Pitts SB, Lea CS, May CL, Stowe C, Hamill DJ, Walker KT, Fitzgerald TL (2013) “Fault-line of an earthquake”: a qualitative examination of barriers and facilitators to colorectal cancer screening in rural, Eastern North Carolina. J Rural Health 29(1):78–87. doi:10.1111/j.1748-0361.2012.00424.x

    Article  PubMed  Google Scholar 

  22. Jones RM, Devers KJ, Kuzel AJ, Woolf SH (2010) Patient-reported barriers to colorectal cancer screening: a mixed-methods analysis. Am J Prev Med 38(5):508–516. doi:10.1016/j.amepre.2010.01.021

    Article  PubMed Central  PubMed  Google Scholar 

  23. Joseph DA, King JB, Miller JW, Richardson LC (2012) Prevalence of colorectal cancer screening among adults—behavioral risk factor surveillance system, United States, 2010. MMWR Morb Mortal Wkly Rep 61:51–56

    PubMed  Google Scholar 

  24. Lau DT, Machizawa S, Demonte W, Cameron KA, Muramatsu N, Henker RD, Chikahisa F, Tanimura M (2013) Colorectal cancer knowledge, attitudes, screening, and intergenerational communication among Japanese American families: an exploratory, community-based participatory study. J Cross-Cult Gerontol 28(1):89–101. doi:10.1007/s10823-012-9184-z

    Article  PubMed Central  PubMed  Google Scholar 

  25. Lee HY, Lundquist M, Ju E, Luo X, Townsend A (2011) Colorectal cancer screening disparities in Asian Americans and Pacific Islanders: which groups are most vulnerable? Ethn Health 16(6):501–518. doi:10.1080/13557858.2011.575219

    Article  PubMed  Google Scholar 

  26. Ma GX, Wang MQ, Toubbeh J, Tan Y, Shive S, Wu D (2012) Factors associated with colorectal cancer screening among Cambodians, Vietnamese, Koreans and Chinese living in the United States. N Am J Med Sci 5(1):1–8

    Article  Google Scholar 

  27. Maxwell AE, Bastani R, Crespi CM, Danao LL, Cayetano RT (2011) Behavioral mediators of colorectal cancer screening in a randomized controlled intervention trial. Prev Med 52(2):167–173. doi:10.1016/j.ypmed.2010.11.007

    Article  PubMed Central  PubMed  Google Scholar 

  28. McLafferty I (2004) Focus group interviews as a data collecting strategy. J Adv Nurs 48(2):187–194. doi:10.1111/j.1365-2648.2004.03186.x

    Article  PubMed  Google Scholar 

  29. Miles MB, Huberman AM (1994) Qualitative data analysis: an expanded sourcebook, 2 Aufl. Sage Publications, Thousand Oaks

    Google Scholar 

  30. Nguyen AT (2011) The Vietnamese population in the United States: 2010. http://www.bpsos.org/mainsite/images/DelawareValley/community_profile/us.census.2010.the%20vietnamese%20population_july%202.2011.pdf. Accessed 1 May 2013

  31. Nguyen GT, Barg FK, Armstrong K, Holmes JH, Hornik RC (2008) Cancer and communication in the health care setting: experiences of older Vietnamese immigrants, a qualitative study. J Gen Intern Med 23(1):45–50. doi:10.1007/s11606-007-0455-2

    Article  PubMed Central  PubMed  Google Scholar 

  32. Nguyen BH, McPhee SJ, Stewart SL, Doan HT (2008) Colorectal cancer screening in Vietnamese Americans. J Cancer Educ 23(1):37–45

    Article  PubMed Central  PubMed  Google Scholar 

  33. Nguyen BH, McPhee SJ, Stewart SL, Doan HT (2010) Effectiveness of a controlled trial to promote colorectal cancer screening in Vietnamese Americans. Am J public health 100(5):870–876. doi:10.2105/AJPH.2009.166231

    Article  PubMed Central  PubMed  Google Scholar 

  34. Nguyen GT, Shungu NP, Niederdeppe J, Barg FK, Holmes JH, Armstrong K, Hornik RC (2010) Cancer-related information seeking and scanning behavior of older Vietnamese immigrants. J Health Commun 15(7):754–768. doi:10.1080/10810730.2010.514034

    Article  PubMed Central  PubMed  Google Scholar 

  35. Nguyen BH, Vo PH, Doan HT, McPhee SJ (2006) Using focus groups to develop interventions to promote colorectal cancer screening among Vietnamese Americans. J Cancer Educ 21:80–83

    Article  PubMed Central  PubMed  Google Scholar 

  36. Nguyen-Truong CK, Lee-Lin F, Leo MC, Gedaly-Duff V, Nail LM, Wang PR, Tran T (2012) A community-based participatory research approach to understanding pap testing adherence among Vietnamese American immigrants. J Obstet Gynecol Neonatal Nurs 41(6):E26–E40. doi:10.1111/j.1552-6909.2012.01414.x

    Article  PubMed  Google Scholar 

  37. Ozturk NA, Gokturk HS, Demir M, Unler GK, Gur G, Yilmaz U (2010) Efficacy and safety of sodium phosphate for colon cleansing in type 2 diabetes mellitus. South Med J 103(11):1097–1102. doi:10.1097/SMJ.0b013e3181f20b13

    Article  PubMed  Google Scholar 

  38. Palmer RC, Midgette LA, Mullan ID (2010) Colorectal cancer screening preferences among African Americans: which screening test is preferred? J Cancer Educ 25(4):577–581. doi:10.1007/s13187-010-0081-2

    Article  PubMed  Google Scholar 

  39. Rabiee F (2004) Focus-group interview and data analysis. Proc Nutr Soc 63(4):655–660

    Article  PubMed  Google Scholar 

  40. Seattle City (2011) Demographics—Population by Race in 2010. http://www.seattle.gov/oir/datasheet/demographics.htm. Accessed 1 May 2013

  41. Shaw SJ, Vivian J, Orzech KM, Torres CH, Armin J (2012) Consistency in attitudes across cancer screenings in medically underserved minority populations. J Cancer Educ 27(1):165–171. doi:10.1007/s13187-011-0285-0

    Article  PubMed Central  PubMed  Google Scholar 

  42. Shokar NK, Vernon SW, Weller SC (2005) Cancer and colorectal cancer: knowledge, beliefs, and screening preferences of a diverse patient population. Fam Med 37(5):341–347

    PubMed  Google Scholar 

  43. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63(1):11–30. doi:10.3322/caac.21166

    Article  PubMed  Google Scholar 

  44. Snapshot of Asian Pacific Americans in Washington State (2012) http://www.capaa.wa.gov/data/washingtonState.shtml. Accessed 1 May 2013

  45. Sun L, Yu S (2012) Diabetes mellitus is an independent risk factor for colorectal cancer. Dig Dis Sci 57(6):1586–1597. doi:10.1007/s10620-012-2059-x

    Article  PubMed  Google Scholar 

  46. Tu SP, Yip MP, Chun A, Choe J, Bastani R, Taylor V (2008) Development of intervention materials for individuals with limited English proficiency: lessons learned from “Colorectal Cancer Screening in Chinese Americans”. Med Care 46(9 Suppl 1):S51–S61. doi:10.1097/MLR.0b013e31817f0cde

    Article  PubMed  Google Scholar 

  47. Tu SP, Yip MP, Li L, Chun A, Taylor V, Yasui Y (2010) Continuity of care and colorectal cancer screening by Vietnamese American patients. Asian Pac J Cancer Prev 11(4):1125–1131

    PubMed Central  PubMed  Google Scholar 

  48. US Preventive Services Task Force (2008) Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 149(9):627–637

    Article  Google Scholar 

  49. Varela A, Jandorf L, Duhamel K (2010) Understanding factors related to Colorectal Cancer (CRC) screening among urban Hispanics: use of focus group methodology. J Cancer Educ 25(1):70–75. doi:10.1007/s13187-009-0015-z

    Article  PubMed Central  PubMed  Google Scholar 

  50. Walsh JM, Kaplan CP, Nguyen B, Gildengorin G, McPhee SJ, Perez-Stable EJ (2004) Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Compared with non-Latino white Americans. J Gen Intern Med 19(2):156–166

    Article  PubMed Central  PubMed  Google Scholar 

  51. Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, Partin MR (2009) Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med 150(7):465–473

    Article  PubMed Central  PubMed  Google Scholar 

  52. Wong ST, Gildengorin G, Nguyen T, Mock J (2005) Disparities in colorectal cancer screening rates among Asian Americans and non-Latino whites. Cancer 104(12 Suppl):2940–2947. doi:10.1002/cncr.21521

    Article  PubMed Central  PubMed  Google Scholar 

  53. Yi M, Xu J, Liu P, Chang GJ, Du XL, Hu CY, Song Y et al (2013) Comparative analysis of lifestyle factors, screening test use, and clinicopathologic features in association with survival among Asian Americans with colorectal cancer. Br J Cancer 108(7):1508–1514. doi:10.1038/bjc.2013.97

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  54. Yuhara H, Steinmaus C, Cohen SE, Corley DA, Tei Y, Buffler PA (2011) Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol 106(11):1911–1921. doi:10.1038/ajg.2011.301, quiz 1922

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Huyen Martin, Loan Nguyen-Phan, the International Community Health Services, the Executive Team, the Management Team, and all the staff who contributed to this collaborative research.

This work was supported by grant R01 CA 124397 from the National Cancer Institute. The National Cancer Institute played no role in the design of the work or the interpretation or presentation of it made here.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA

    Amanda Kimura & Anh Tran

  2. College of Nursing, Seattle University, 901 12th Avenue, Seattle, WA, 98122, USA

    Mo-Kyung Sin

  3. Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Clarence Spigner & Shin-Ping Tu

  4. Department of Medicine, Virginia Commonwealth University, 1201 East Marshall Street, Richmond, VA, 23298, USA

    Shin-Ping Tu

  5. McGlothlin Medical Education Center, 12th Floor, Room 210, 1201 East Marshall Street, P.O. Box 980070, Richmond, VA, 23298-0070, USA

    Shin-Ping Tu

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  1. Amanda Kimura
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  2. Mo-Kyung Sin
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Correspondence to Shin-Ping Tu.

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Kimura, A., Sin, MK., Spigner, C. et al. Barriers and Facilitators to Colorectal Cancer Screening in Vietnamese Americans: A Qualitative Analysis. J Canc Educ 29, 728–734 (2014). https://doi.org/10.1007/s13187-014-0646-6

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