Shin Ping Tu

Promoting Culturally Appropriate Colorectal Cancer Screening Through a Health Educator A Randomized Controlled Trial

Colorectal cancer (CRC) is a leading cause of cancer mortality in the US. Surveys reveal low CRC screening levels among Asians in the US, including Chinese Americans.

Systems Antecedents for Dissemination and Implementation A Review and Analysis of Measures

There is a growing emphasis on the role of organizations as settings for dissemination and implementation. Only recently has the field begun to consider features of organizations that affect dissemination and implementation of evidence-based interventions. This manuscript identifies and evaluates available measures for five key organizational-level constructs: (a) leadership, (b) vision, (c) managerial relations, (d) climate, and (e) absorptive capacity. Overall the picture was the same across the five constructs—no measure was used in more than one study, many studies did not report the psychometric properties of the measures, some assessments were based on a single response per unit, and the level of the instrument and analysis did not always match. One must seriously consider the development and evaluation of a robust set of measures that will serve as the basis of building the field, allow for comparisons across organizational types and intervention topics, and allow a robust area of dissemination and implementation research to develop.

Clinical Trials: Understanding and Perceptions of Female Chinese-American Cancer Patients

Under‐representation of minority and female participants prompted the U.S. legislature to mandate the inclusion of women and minorities in federally funded research. Recruitment of minorities to participate in clinical trials continues to be challenging. Although Asian Americans constitute one of the major minority groups in the U.S., published literature contains sparse data concerning the participation of Asian Americans in cancer clinical trials. The authors completed qualitative, semistructured interviews with 34 participants: Chinese‐American female cancer patients ages 20–85 years or their family members. Interviews were conducted in Cantonese, Mandarin, or English and were audiotaped. Chinese interviews were translated into English, and all interviews were transcribed subsequently into English. A team of five coders individually reviewed then met to discuss the English transcripts. The authors used the constant comparative technique throughout the entire coding process as part of the analysis. Among participants, 62% lacked any knowledge of clinical trials, and many expressed negative attitudes toward clinical trials. Barriers to participation included inadequate resources, language issues, and a lack of financial and social support. Facilitating factors included recommendations by a trusted oncologist or another trusted individual and information in the appropriate language. It is noteworthy that family members played an important role in the cancer experience of these participants. To promote participation, there is a need to increase knowledge of clinical trials among Chinese cancer patients. It also is necessary to examine the applicability of current patient‐physician communication and interaction models. In addition, decision‐making based on Asian philosophies within the context of Euro‐American bioethics requires further study. Cancer 2005.

The End of the 15–20 Minute Primary Care Visit

Division of General Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA; HarvardMedical School, Boston,MA, USA; Virginia Commonwealth University, Richmond, VA, USA; University of Virginia, Charlottesville, VA, USA; Louis Stokes Cleveland VAMC, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; New York University School of Medicine, New York, NY, USA.

Adaptation of an evidence-based intervention to promote colorectal cancer screening: a quasi-experimental study

BackgroundTo accelerate the translation of research findings into practice for underserved populations, we investigated the adaptation of an evidence-based intervention (EBI), designed to increase colorectal cancer (CRC) screening in one limited English-proficient (LEP) population (Chinese), for another LEP group (Vietnamese) with overlapping cultural and health beliefs.MethodsGuided by Diffusion of Innovations Theory, we adapted the EBI to achieve greater reach. Core elements of the adapted intervention included: small media (a DVD and pamphlet) translated into Vietnamese from Chinese; medical assistants distributing the small media instead of a health educator; and presentations on CRC screening to the medical assistants. A quasi-experimental study examined CRC screening adherence among eligible Vietnamese patients at the intervention and control clinics, before and after the 24-month intervention. The proportion of the adherence was assessed using generalized linear mixed models that account for clustering under primary care providers and also within-patient correlation between baseline and follow up.ResultsOur study included two cross-sectional samples: 1,016 at baseline (604 in the intervention clinic and 412 in the control clinic) and 1,260 post-intervention (746 in the intervention and 514 in the control clinic), including appreciable overlaps between the two time points. Pre-post change in CRC screening over time, expressed as an odds ratio (OR) of CRC screening adherence by time, showed a marginally-significant greater increase in CRC screening adherence at the intervention clinic compared to the control clinic (the ratio of the two ORs = 1.42; 95% CI 0.95, 2.15). In the sample of patients who were non-adherent to CRC screening at baseline, compared to the control clinic, the intervention clinic had marginally-significant greater increase in FOBT (adjusted OR = 1.77; 95% CI 0.98, 3.18) and a statistically-significantly greater increase in CRC screening adherence (adjusted OR = 1.70; 95% CI 1.05, 2.75).ConclusionsTheoretically guided adaptations of EBIs may accelerate the translation of research into practice. Adaptation has the potential to mitigate health disparities for hard-to-reach populations in a timely manner.

Communicating With Pictures: Perceptions of Cardiovascular Health Among Asian Immigrants

CARDIOVASCULAR DISEASE (CVD) is one of the leading causes of morbidity and mortality in the United States, and does not discriminate by ethnicity.1 In fact, the health of many US ethnic minorities, especially immigrants, is known to be poorer than their Caucasian counterparts living at similar socio-economic levels and geographic regions.2–5 Issues related to poverty, heath care access, and quality of care greatly impact rates of disease once immigrants arrive in this country.6,7 Efforts to develop health promotion programs to decrease risk factors for CVD are complex because of language and cultural issues that must be addressed for efforts to succeed. It is important to “see” what a targeted group sees, to understand how they view specific topics if one intends messages to relate to them.

Reported Use of Electronic Health Records to Implement Evidence Based Approaches to Colorectal Cancer Screening in Community Health Centers

Background. Community health centers (CHCs) are critical sources of primary care for medically underserved populations. Electronic health records (EHRs) are important for implementation of evidence-based approaches for cancer control. Methods. Cross-sectional study of CHCs from the Cancer Prevention Control Research Network’s community health center Clinic Characteristics Survey. Proportions of CHCs using EHR data to: 1) measure colorectal cancer screening, 2) deliver reports, and 3) provide patient reminders for colorectal cancer screening. Results. Only 27% of CHCs perceive EHR system’s colorectal cancer screening data as very accurate. Over half (57%) of respondent CHCs with EHRs reported it is easy or very easy to do colorectal cancer screening activities using EHR systems. Conclusions. Poor EHR data quality and cumbersome EHR systems may be significant barriers to implementation of evidence-based approaches to colorectal cancer screening in CHCs.

Practice adaptive reserve and colorectal cancer screening best practices at community health center clinics in 7 states

Enhancing the capability of community health centers to implement best practices (BPs) may mitigate health disparities. This study investigated the association of practice adaptive reserve (PAR) with the implementation of patient‐centered medical home (PCMH) colorectal cancer (CRC) screening BPs at community health center clinics in 7 states.

Measuring constructs from the Consolidated Framework for Implementation Research in the context of increasing colorectal cancer screening at community health centers

Background The Consolidated Framework for Implementation Research (CFIR) is a comprehensive meta-framework widely applied to implementation related studies. Yet, few have used validated measures to operationalize constructs in CFIR in real-life settings. In this study, we operationalized selected CFIR constructs in an assessment to identify factors influencing implementation of evidence-based practices for increasing colorectal cancer screening in Community Health Centers (CHC).

Promoting Chinese-Speaking Primary Care Physicians' Communication with Immigrant Patients about Colorectal Cancer Screening: A Cluster Randomized Trial Design

Chinese Americans underutilize colorectal cancer screening. This study evaluated a physician-based intervention guided by social cognitive theory (SCT) to inform future research involving minority physicians and patients. Twenty-five Chinese-speaking primary care physicians were randomized into intervention or usual care arms. The intervention included two 45-minute in-office training sessions paired with a dual-language communication guide detailing strategies in addressing Chinese patients’ screening barriers. Physicians’ feedback on the intervention, their performance data during training, and pre-post intervention survey data were collected and analyzed. Most physicians (~85%) liked the intervention materials but ~84% spent less than 20 minutes reading the guide and only 46% found the length of time for in-office training acceptable. Despite this, the intervention increased physicians’ perceived communication self-efficacy with patients (p<.01). This study demonstrated the feasibility of enrolling and intervening with minority physicians. Time constraints in primary care practice should be considered in the design and implementation of interventions.