Karen Kim

Evaluating screening colonoscopy quality in an uninsured urban population following patient navigation

Patient navigation (PN) increases screening colonoscopy completion in minority and uninsured populations. However, colonoscopy quality is under-reported in the setting of PN and quality indicators have often failed to meet benchmark standards. This study investigated screening colonoscopy quality indicators after year-one of a PN initiative targeting the medically uninsured. This was a retrospective analysis of 296 outpatient screening colonoscopies. Patients were 45 to 75 years of age with no history of bowel cancer, inflammatory bowel disease, or colorectal surgery. The screening colonoscopy quality indicators: adenoma detection rate (ADR), cecal intubation rate (CIR), and bowel preparation quality were compared in 89 uninsured Federally Qualified Health Center (FQHC) patients who received PN and 207 University Hospital patients who received usual care. The FQHC PN and University Hospital cohorts were similar in female sex (69% vs. 70%; p = 0.861) and African American race (61% vs. 61%; p = 0.920). The FQHC PN cohort was younger (57 years vs. 60 years; p < 0.001). There was no difference in ADR (33% vs. 32%; p = 0.971) or CIR (96% vs. 95%; p = 0.900) comparing the FQHC PN and University Hospital cohorts. The FQHC PN patients had a greater likelihood of an optimal bowel preparation on multivariate logistic regression (odds ratio 4.17; 95% confidence interval 1.07 to 16.20). Uninsured FQHC patients who received PN were observed to have intra-procedure quality indicators that exceeded bench-mark standards for high-quality screening colonoscopy and were equivalent to those observed in an insured University Hospital patient population.

Community-based services to improve testing and linkage to care among non–U.S.-Born persons with chronic hepatitis B virus infection — three U.S. programs, october 2014–september 2017

Among an estimated 850,000 to 2.2 million persons with chronic hepatitis B virus (HBV) infection in the United States, 70% are non-U.S.-born (1,2). All patients require linkage to care, and approximately 20%-40% require antiviral treatment (3). Without treatment, one in four persons chronically infected with HBV will die prematurely from liver failure, liver cirrhosis, or hepatocellular carcinoma (4). To mitigate morbidity and mortality, CDC funded a cooperative agreement to develop hepatitis B testing and linkage-to-care programs serving non-U.S.-born persons during October 2014-September 2017. This report describes each programs operational services and partnerships with primary care centers, community-based organizations, and public health departments to recruit non-U.S.-born persons for HBV testing using the hepatitis B surface antigen (HBsAg) and link those whose test results were positive to HBV-directed care (medical visit attendance with monitoring of HBV DNA and liver enzyme tests). Among 10,152 program participants, 757 (7.5%) were HBsAg-positive, indicative of chronic HBV infection; among these, 643 (85%) attended ≥1 medical visit, 587 (78%) received HBV-directed care, and 137 (18%) were prescribed antiviral treatment. Among 273 household contacts of HBsAg-positive persons, 39 (14%) had positive test results for HBsAg. Prevalence of current HBV infection was high in this non-U.S.-born population and among household and sexual contacts of HBV-infected persons. HBV testing and linkage to care can be achieved through partnerships with community organizations, health centers, and public health departments.

Promoting Colorectal Cancer Screening in Foreign-Born Chinese-American Women: Does Racial/Ethnic and Language Concordance Matter?

Chinese Americans are one of the fastest-growing and largest Asian-American subgroups. Approximately 70% of Chinese Americans are immigrants with 46% being of limited English proficiency. Despite colorectal cancer (CRC) being the second leading cause of cancer death in Chinese Americans, Chinese Americans have lower CRC screening rates than other Asian subgroups, and only 40% of CRC cases among Chinese Americans are diagnosed early. Furthermore, CRC is the second most common cancer among Chinese American women. Race/ethnicity concordant providers may process culturally specific knowledge, skills, and experience that may facilitate better communication. Although using an interpreter can help to overcome language barriers between providers and patients, it may not achieve the same level of communication as a language concordant provider. The purpose of this study was to test a community education intervention, taking into account the racial/ethnic and language concordance of the presenter, to increase CRC screening uptake among foreign-born Chinese American women. This study used a quasi-experimental design and a convenience sample of 198 foreign-born Chinese-American women. Logistic regression was used to examine the effect of racial/ethnic and language concordance of the presenter on the return of completed FOBT kits for testing. The Chinese/English-speaking presenter had the highest return rate (73%), followed by the White/English-speaking presenter (61%), and the Chinese/Chinese-speaking presenter (48%), and the differences were statistically significant. Post-education intention to screen was also a significant predictor for returning the FOBT kit for testing. The use of an interpreter did not decrease the effectiveness of the educational intervention.

Abstract A16: Asian immigrants' perception of clinical trials

Background Racial/ethnic minorities constitute more than 30% of the U.S. population, and yet represent less than 18% of clinical trial (CT) participation. The participation of minorities in CTs is a critical link between scientific innovation and improvement in health care delivery, as well as the provision of evidence-based medicine. Although Asian Americans (AAs) are the fastest growing minority group in the U.S., they are the least represented in CTs. Specifically, more than 65% of AAs are foreign-born, and greater than 30% have limited English proficiency. Little is known about AA immigrants9 willingness to participate in CTs. The purpose of this study was to examine (1) AA immigrants9 perception of CTs and (2) how sociodemographic factors might influence their perception. Methods This study used a cross-sectional design and quota sampling. Participants were recruited through seven AA community-based organizations and from six AA subgroups (Cambodian, Chinese, Filipino, Korean, Laotian, South Asians, and Vietnamese). An eight-item survey tool was developed to measure perceived benefits and cost of participating in CTs. The survey tool consisted of four positive statements and four negative statements. Participants were asked to rate each statement on a 5-likert scale. A total perception score was calculated by adding all eight items. A higher score indicates a more positive perception. The score can range from 0 to 40. The survey tool was translated, back translated in participants9 native language. Results 470 participants completed the survey and 459 (98%) were immigrants. 48% of the participants had family income less than

Abstract A30: The role of community health workers in disseminating colorectal cancer guidelines in Asian Americans

20,000/year, 32% had less than 9 years of education, 39% reported less than average English proficiency. 26% of the participants were less than 50 years old (mean age = 56) and 27% were in the U.S. less than 10 years (mean years = 20). The Cronbach9s Alpha for the perception scale was 0.64. The average perception score was 28.5 (SD = 4.03) and ranged from 18 to 40. There was a significant differences in the perception score across the seven subgroups. Both Vietnamese and Cambodian communities had the lowest perception scores (mean = 26.58 and 26.83, respectively); while Filipinos community had the highest perception score (mean = 30.20). The majority believed CTs could be beneficial to their community (83%) and helpful to advance medical knowledge and improve treatment (87%), as well as provide patients with an opportunity to try new treatment (86%). 70% of participants indicated that they would consider participation in clinical trials if they knew more about it. Participants who had less than 9 years education had significantly lower perception score than participants who had more than 9 years education (p

Abstract A14: Digital health information access among Asian Americans

20,000/year (p = .003). Participants whose English proficiency less than average also had significantly lower perception score (p Conclusion The inclusion of AAs in clinical trials is critical for the mitigation of disparities and for realizing the true promise of precision medicine in cancer prevention and treatment. It is often argued that racial/ethnic minorities do not participate in CTs because they don9t understand the importance of CTs or distrust the system. However, our findings challenge these assumptions. It will require greater effort and commitment on the part of institutions and researchers to recruit and enroll hard-to-reach populations in CTs. Steps must be taken to assure the inclusion and representation of racial/ethnic minorities. Citation Format: Helen Lam, Michael Quinn, Edwin Chandrasekar, Reena Patel, Karen Kim. Asian immigrants9 perception of clinical trials. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A16.

Abstract A31: Evaluating a diverse and cross community and academic partnership to promote colorectal cancer screening guidelines

Background Community health workers (CHWs) are lay people from within the communities where they work, who share common characteristics with their members, such as ethnicity, culture, and language. They are frontline health workers who often serve socially and linguistically isolated populations. As trusted members of their communities, they provide critical links between community and systems of care. CHWs can empower community members with enhanced health knowledge, help navigating health systems, and access to care. This study examined the central role of CHWs in disseminating colorectal cancer screening guidelines in seven Asian immigrant communities (Cambodian, Chinese, Filipino, Korean, Lao, South Asian, and Vietnamese) in Chicago. Method The parent project was designed to use a community-centered dissemination model to promote the adoption of colorectal cancer (CRC) screening guidelines in seven Asian communities. In this study, we used social marketing campaign and CHWs as part of the intervention to disseminate CRC screening guidelines. Although social marketing campaigns can create public awareness, they rarely shape attitudes and bring behavior change. To take community members from awareness to commitment and then action, we used CHWs as influencers. All ten CHWs recruited in this study were bicultural and bilingual health professionals. In addition, all CHWs had at least a bachelor9s degree, had worked in the community for more than a year and well understood the social norms of the community. All CHWs were required to attend a 6-hour training course on CRC screening, motivational interviewing techniques, and the application of Stage of Change Theory. A CHW guidebook, which listed rationales and components of the intervention, was given to the CHWs. The roles and responsibilities of the CHW (outreaching, educating, navigating and collecting data) were also clearly stated in the guidebook. All CHEs were committed 20 hours/week for the project during the 12-week intervention period. Both quantitative and qualitative data were collected during and after the CHW intervention through weekly activity logs, site visits notes, and focus groups with implementation CHWs at the end of the project. Results Our ten CHWs placed 320 posters (in English or native language) to promote CRC screening in different venues, such as restaurants, churches, temples, and grocery stores, that were frequented by local community members. They also sent out 4,665 CRC postcards to clients on their mail lists. Besides one-on-one counselling session, CHW also conducted 32 CRC information sessions (> 5 people). Across the seven communities, over 2,400 community residents were reached through one-on-one education or small group information sessions over the 12-week intervention period. Most of the CHWs used familiar places to do their outreach, such as in-house programs (e.g. senior services or immigrant programs) or other places that they have implemented programs before. They also used other opportunities, such when they were shopping at the community store or in a bible study, as well as family and friend gatherings, to disseminate CRC screening guidelines. Although not all people they encountered wanted to be screened, they felt that they at least got them thinking about CRC and had impact on them. For personal experience, most CHWs stated that the project increased their knowledge of CRC and they also felt valued. Discussion Participation of CHWs in this demonstration project was invaluable. Each CHW brought critical knowledge of their community, its language, values, norms, and health beliefs. CHWs are uniquely positioned to deliver culturally ad linguistically tailored intervention and can serve as a source of peer support and social influence. Citation Format: Karen Kim, Michael Quinn, Edwin Chandrasekar, Helen Lam. The role of community health workers in disseminating colorectal cancer guidelines in Asian Americans. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A30.

Abstract A29: Disseminating colorectal cancer screening guidelines in Asian-American communities using a market-oriented and multilevel approach

Background Access to health information is essential to patient-centered healthcare. Healthy People 2020 recommended three key strategies for improving health outcomes and narrowing health disparities. One of the key strategies is to provide equitable access to health information. Digital technology holds great promise in helping to reduce health disparities. In fact, recent studies indicate that the “digital divide” is narrowing between racial/ethnic minorities and the general population. The question remains, however, on whether or not all groups have equal access to digital health information. Asian Americans (AAs) are the fastest growing minority group in the U.S. More than 65% of AAs are foreign-born, and greater than 30% have limited English proficiency. Non-English speaking AAs were not specifically targeted in previous digital technology ownership and usage surveys. However, such information is important to ensure equal access to digital cancer control information and other health information. Objective The purpose of this study was to examine (1) the most common channels that AA immigrants use to obtain health information, and (2) factors predicting the ownership and usage of computers, as well as the use of the Internet to obtain health information. Methods This study used a cross-sectional design and quota sampling. Participants were recruited through seven community-based organizations and from six Asian subgroups (Cambodian, Chinese, Filipinos, Korean, Laotian, South Asians and Vietnamese) . Participants were asked where they usually received helpful health information. They were also asked whether they had a computer at home and knew how to use it, as well as whether they used the Internet to obtain health information. Surveys were conducted in participants9 native language. Only data from participants who were foreign-born were used in the statistical analysis. Results 403 participants completed the survey and 395 (98%) were foreign-born. 49% had family income

Partnership for Healthier Asians: Disseminating Evidence-Based Practices in Asian-American Communities Using a Market-Oriented and Multilevel Approach.

20,000/year (p

Abstract B77: Knowledge of screening colonoscopy results and follow up recommendations among navigated patients

20,000/year (p Conclusion Despite a narrowing racial/ethnic “digital divide”, disparities still exist, particularly among Asian immigrants with low social economic status, less years of education and limited English proficiency. New interventions are needed to target underserved AA subpopulations and help them to gain access to digital health information and develop information seeking skills. Citation Format: Helen Lam, Michael Quinn, Edwin Chandrasekar, Karen Kim. Digital health information access among Asian Americans. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A14.