Differences in Knowledge, Attitudes, Beliefs, and Perceived Risks Regarding Colorectal Cancer Screening Among Chinese, Korean, and Vietnamese Sub-Groups

Abstract

Background Asian ethnic subgroups are often treated as a single demographic group in studies looking at cancer screening and health disparities. Purpose To evaluate knowledge and health beliefs associated with colorectal cancer (CRC) and CRC screening among Chinese, Korean, and Vietnamese subgroups. Methods A survey assessed participants’ demographic characteristics, healthcare utilization, knowledge, beliefs, attitudes associated with CRC and CRC screening. Exploratory factor analysis identified six factors accounting >60% of the total variance in beliefs and attitudes. Cronbach’s alpha coefficients assessed internal consistency. Differences among Asian subgroups were assessed using a chi-square, Fisher’s exact, or Kruskal-Wallis test. Pearson’s correlation coefficient assessed an association among factors. Results 654 participants enrolled: 238 Chinese, 217 Korean, and 199 Vietnamese. Statistically significant differences existed in demographic and health care provider characteristics, knowledge, and attitude/belief variables regarding CRC. These included knowledge of CRC screening modalities, reluctance to discuss cancer, belief that cancer is preventable by diet and lifestyle, and intention to undergo CRC screening. Chinese subjects were more likely to use Eastern medicine (52% Chinese, 25% Korean, 27% Vietnamese; p < 0.001); Korean subjects were less likely to see herbs as a form of cancer prevention (34% Chinese, 20% Korean, 35% Vietnamese; p < 0.001). Vietnamese subjects were less likely to consider CRC screening (95% Chinese, 95% Korean, 80% Vietnamese; p < 0.0001). Conclusion Important differences exist in knowledge, attitudes, and health beliefs among Asian subgroups. Understanding these differences will enable clinicians to deliver tailored, effective health messages to improve CRC screening and other health behaviors.

Colorectal cancer beliefs, knowledge, and screening among Filipino, Hmong, and Korean Americans

“…It is possible that Asian Americans with a preventive orientation may look for help from a variety of sources including self-care, traditional medicine, and biomedical approaches. 13 Having various beliefs indicate that participants are interested in preventing CRC. One implication for interventions is that there may not be a need to discourage people from having beliefs about CRC prevention if they are not harmful as long as they are also taught about the proven methods.…”

“…11,12 Fatalism, a common Asian belief that illness is beyond one’s control, is inversely associated with cancer screening. 13,14 Additionally, many Asian Americans believe that certain foods or herbs can prevent cancer, 14 which may affect their decision to get screened.…”

Improving colorectal cancer screening in Asian Americans: Results of a randomized intervention study

“…Many people of various cultures are uncomfortable with the idea of randomization, so this strength is not inconsequential. Another strength includes our use of an instrument we designed and psychometrically tested (26) indicating the measures were valid. Also, we were able to capture complete data on participants in both study groups and the extent of attendance at the educational intervention.…”

“…It has been applied to studies of the relationships among beliefs, attitudes, behavioral intentions and behaviors in many fields including healthcare and patient self care (23–25). We conducted an exploratory factor analysis using the baseline survey responses and further revised domains, the results of which are reported elsewhere (26). The demographic questions were administered once at baseline to all study participants.…”

Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study

“…A possible barrier to CRC screening among Chinese Americans may be lack of awareness (4). Other studies of Chinese immigrants have noted a lack of understanding of CRC screening as a preventive measure, as well as challenges with language, transportation, access to health care, limited social support for use of screening services, and lack of health insurance (5–7). A review of 30 culturally appropriate cancer screening intervention studies found that community-based and lay health worker strategies were effective in improving cancer screening rates among Asian Americans.…”