(WITHDRAWN) What Are the Effects of Colorectal Cancer Screening Interventions Among Asian Americans? a Meta-Analysis

Background & Purpose: Significant efforts have been made to improve the collection of Asian American (AA) colorectal cancer (CRC) data, including identifying determinants to CRC screening practice. CRC is preventable, and if detected early, can greatly decrease cancer-related morbidity and premature mortality. As such, great strides have been made to conduct intervention studies aimed at increasing CRC screening rates that are informed by sound theoretical frameworks and conducted using rigorous methodologies. However, efforts are still gaining wave to understand the efficacy of these interventions among AA population. The purpose of this study was to report the results of a meta-analysis conducted on the effects of CRC screening interventions among AA.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to evaluate the CRC screening interventions. Literature search was performed on October 2018, and studies published in English and conducted in the United States were eligible for inclusion if they 1) conducted interventions with aims to increase CRC screening rates among AA and 2) utilized a randomized control trial (RCT) or quasi-experimental study design, 3) reported quantitative screening rates following the intervention, and 4) included a comparison or control group for comparison.

Result: In total, 14 of the studies’ Odds Ratio were included in the meta-analysis. All 14 studies used an intervention that was culturally responsive to their participants’ race/ethnicity, and close to half of all the studies used lay health worker intervention. Overall, results indicated that AA participants who received the experimental screening interventions aimed at improving screening were 1.78 times more likely to obtain a CRC screening at post-intervention compared to those receiving usual care or comparison control intervention, OR = 1.78 (95% CI = 1.44, 2.11). When analysis was stratified by study design type, RCT and quasi-experimental design, only the RCT designs were statistically significant OR = 1.86 (95% CI = 1.46, 2.27) versus quasi-experiment designs OR = 1.57 (95% CI = 0.75, 2.39).

Conclusion & Implications: Understanding the efficacy of interventions designed to promote CRC screening among AA population is imperative to decrease CRC burden and mortality among AA. Although research in this area is limited, this review sheds light on important socio-cultural strategies to developing a CRC screening intervention aimed at increasing screening rates among AA. Findings in this review corroborate with previous studies that improvement in screening behavior can be achieved through a variety of ways, but the common feature across all the studies were the culturally responsive foundation of their respective interventions. It will also be imperative to continue engaging in the use of robust methodologies and theoretically and community-informed prevention and early intervention research. Next steps should include the exploration of unique characteristics of the interventions by AA ethnic group including the use of traditional providers to assist with outreach efforts and to serve as intervention providers for hard to reach AA subgroups.This review strongly supports the call for ongoing culturally and community tailored interventions to promote CRC screening among AA populations.