Motivating Underserved Vietnamese Americans to Obtain Colorectal Cancer Screening: A Culturally Tailored Video-Based Intervention Using a Community-Based Participatory Research Approach

Background. This project aimed to address the high colorectal cancer (CRC) burden and low rates of screening in the Minneapolis—St. Paul Vietnamese American community, which faces multiple cultural and structural barriers to CRC screening. This pilot study investigated the effectiveness of a culturally tailored DVD intervention in increasing Vietnamese Americans' motivation to undergo recommended screening. The educational video was developed in Vietnamese by the Vietnamese Social Services of Minnesota and consists of physicians describing CRC and CRC screening guidelines, community members sharing personal narratives, and a screening demonstration by health professionals. The potential acceptability and effectiveness of this video-based intervention were examined, compared to a typical written intervention. Participants' knowledge, attitudes, and beliefs about CRC screening, receipt of CRC screening and their relationship to intervention effectiveness were explored.

Method. Using a community-based participatory research approach, a randomized controlled trial was conducted with an experimental (mailed DVD in Vietnamese, n=28) and control group (mailed brochure intervention, also in Vietnamese, n=28). Participants (female=37, male=19) were aged 50 and older (mean=61) who had never undergone CRC screening. Subjects completed a baseline survey assessing demographics, health access, acculturation, cultural attitudes toward cancer screening, and knowledge of CRC and screening guideline. Shorter assessments of knowledge, attitudes, and receipt of CRC screening were conducted one month post-intervention. Focus groups explored barriers or facilitators to CRC screening, acceptability of the intervention, and attitudes and beliefs about CRC and screening. The main outcome measure was receipt of CRC screening during the intervention period. Knowledge and attitudes toward CRC screening were again measured. Data analysis was conducted using STATA 9.0.

Findings. Baseline survey results showed that over 60% of participants had never heard of polyps or colon cancer. Between 57% and 66% had never heard of a FOBT, sigmoidoscopy, or colonoscopy. Similar outcomes were observed in both experimental and control groups in terms of CRC terminology acquisition (e.g., colon cancer, FOBT, sigmoidoscopy, and colonoscopy) at one month post-intervention interview that all participants heard of the terminologies. Furthermore, a remarkable 20% increase in colonoscopy receipt was seen across groups. Interestingly, the control group showed a slightly greater increase in positive attitudes toward the FOBT and colonoscopy.

Conclusions. The results revealed that intervention type may be less important than culturally tailored, linguistically appropriate content. Since Vietnamese Americans are generally well educated, printed and DVD interventions may yield similar outcomes . When disseminating these research findings to other underserved groups—such as Hmong Americans, other AAPI groups, or rural communities—consideration of particular group characteristics (e.g. literacy) must inform screening interventions aimed at cancer screening and control.