Background Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic Whites. Hmong Americans have limited socioeconomic resources and literacy. This randomized controlled trial (RCT) was conducted to determine if bilingual/bicultural lay health educator (LHE) education can increase CRC screening among Hmong Americans Methods We conducted a cluster RCT among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by a LHE. The control group received education about nutrition and physical activity delivered by a health educator. The outcomes were change in self-reported ever and up-to-date CRC screening after 6 months. Results All participants (n=329) were foreign-born with mostly no formal education, limited English proficiency, and no employment. Most were insured and had a regular place for care. The intervention group had greater changes after the intervention than the control group for ever screening (p=0.068) and being up-to-date (p<0.0001). In multivariable regression analyses, the intervention group had a greater increase than the control group in reporting ever screening (AOR = 1.73, 95% CI: 1.07–2.79) and being up-to-date (AOR = 1.71, 95% CI: 1.26–2.32). Having health insurance had > 4 times the odds for receiving screening, both ever and up-to-date. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. Conclusions A culturally and linguistically appropriate educational intervention delivered by trained LHEs increases colorectal cancer screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Trial Registration Clinicaltrials.gov # NCT01904890

Compared with a brochure, LHE outreach yielded greater increases in knowledge but resulted in similar increases in CRC screening in a Korean American population with barriers to health care access. More work is needed to appropriately address logistical and system barriers in this community. Cancer 2017;123:2705-15. © 2017 American Cancer Society.

Asian Americans are the fastest growing ethnic group in U.S. However, they represent only 1.7% of U.S. cancer clinical trial participants. This pilot study describes findings on barriers, promoters and recommendations related to cancer clinical trial participation from Asian Americans. The research team conducted 3 focus groups comprised of 21 community members and 4 key informant interviews with healthcare providers. Qualitative methodology was used to identify themes about cancer clinical trial participation. Barriers and promoters were categorized based on themes identified and previous study findings. Eight major themes and 5 recommendations were identified from the focus group data. Five major themes and 7 recommendations were identified from the key informant data. Asian Americans' decision to participate in cancer clinical trials is largely influenced by their cultural values and practices such as altruism and family-based decision making process. Technology platforms provide promising venues to reach Asian Americans. Family-based decision making process, altruism, and the use of technology platforms may need to be considered when outreaching to Asian Americans on cancer clinical trial participation.