Significant racial disparities in cancer mortality are seen between Medicare beneficiaries. A randomized controlled trial tested the use of lay navigators (care managers) to increase cancer screening of Asian and Pacific Islander Medicare beneficiaries. The study setting was Moloka‘i General Hospital on the island of Moloka‘i, Hawai‘i, which was one of six sites participating in the Cancer Prevention and Treatment Demonstration sponsored by the Centers for Medicare and Medicaid Services. Between 2006 and 2009, 488 Medicare beneficiaries (45% Hawaiian, 35% Filipino, 11% Japanese, 8% other) were randomized to have a navigator help them access cancer screening services (experimental condition, n = 242) or cancer education (control condition, n = 246). Self-reported data on screening participation were collected at baseline and exit from the study, and differences were tested using chi-square. Groups were similar in demographic characteristics and baseline screening prevalence of breast, cervical, prostate, and colorectal cancers. At study exit, 57.0% of women in the experimental arm and 36.4% of controls had had a Papanicolaou test in the past 24 months (P = .001), 61.7% of women in the experimental arm and 42.4% of controls had had a mammogram in the past 12 months (P = .003), 54.4% of men in the experimental arm and 36.0% of controls had had a prostate-specific antigen test in the past 12 months (P = .008), and 43.0% of both sexes in the experimental arm and 27.2% of controls had had a flexible sigmoidoscopy or colonoscopy in the past 5 years (P < .001). Findings suggest that navigation services can increase cancer screening in Medicare beneficiaries in groups with significant disparities.

In the U.S., colorectal cancer (CRC) incidence and mortality have declined due to screening and improvements in early detection; however, racial/ethnic disparities in screening and mortality persist. Patient navigation has been shown to be effective in increasing CRC screening prevalence. This systematic review answered three questions about navigation in federally qualified community health centers (FQHCs): 1) Which navigation activities increased CRC screening prevalence? 2) What were the challenges to implementing these programs in FQHCs? 3) Which clinic protocols supported screening completion? Findings suggest that navigation services must be tailored to the specific screening test provided. Federally qualified community health centers report difficulty maintaining a current electronic medical records system and sustaining funding; they should establish excellent patient tracking systems (for follow-up and annual rescreening) and establish multiple protocols to facilitate screening completion. With the movement toward patient-centered care models, patient navigation will be integral to FQHCs and their clients.

Colorectal cancer (CRC) screening prevalence remains low among Asians and Pacific Islanders. This study examined disparities and predictors of CRC screening compliance in adults age 50-75 years in Asians and Pacific Islanders in Hawai'i. Hawai'i Behavioral Risk Factor Surveillance System (BRFSS) data for 2011-2014 were analyzed. CRC screening status was dichotomized. Logistic regression was used to examine ethnic differences in and predictors of CRC screening status. Filipinos (OR 0.56), Chinese (OR 0.70), and Hawaiians (OR 0.75) were significantly less likely than whites to be CRC compliant. Higher education and income, employment, regular health provider, and routine checkups were important predictors of CRC compliance. Findings confirm lower CRC screening compliance in three of the four largest Asian and Pacific Islander groups in Hawai'i and that CRC screening compliance is influenced by several factors. Culturally tailored education and navigation services may be effective in reducing these disparities.

IntroductionCultural tailoring of interventions can be effective in reducing health disparities by attracting underserved populations to health promotion programs and improving their outcomes. The purpose of this systematic review was to assess what is known about increasing access to and participation in cardiovascular disease (CVD) prevention and control programs among Filipino Americans.MethodsPubMed MEDLINE, CINAHL, and Sociologic Abstracts were searched for peer-reviewed studies and dissertations conducted in the United States from 2004 through 2016.ResultsA total of 347 articles were identified through the search, and 9 articles reporting on 7 interventions focused on CVD prevention in a Filipino American sample were included. All but one intervention used evidence-based curricula, and implementation varied across sites. All but 2 interventions used word-of-mouth advertising from friends, family, and community leaders to increase participation. The Filipino cultural values of food, social relationships, and family were prevalent aspects across interventions tailored for Filipino Americans. Aspects of spirituality and the arts were integrated into only 3 studies.ConclusionGiven the burden of CVD in Filipino American populations, tailored interventions rooted in Filipino cultural values are vital to address this known health disparity.

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