Authors:

• Winnie K.W. So, RN, PhD, FAAN; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
• Dorothy N.S. Chan, RN, PhD; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
• Bernard M.H. Law, PhD; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
• Kai Chow Choi, PhD; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
• Meinir Krishnasamy, RGN, PhD; Peter MacCallum Cancer Centre, Victoria, Australia;
• Carmen W.H. Chan, RN, PhD, FAAN; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;

Submission topic:
A Family-based Multimedia Intervention: A Potential Strategy to Promoting Colorectal Cancer Screening Utilisation among South Asian Ethnic Minorities

Colorectal cancer (CRC) is one of the most common cancers in Hong Kong. In view of the benefit of cancer screening utilisation in reducing CRC prevalence, the local government had started implementing a CRC screening programme that enable the public to undergo screening tests (faecal immunohistochemical test – FIT) at a reduced cost. Nevertheless, South Asian (SA) ethnic minorities, one of the disadvantaged populations in Hong Kong, were known to exhibit a low CRC screening rates.1 They face multiple barriers in utilising the available CRC screening services, including the language barrier, and limited knowledge on CRC prevention and screening.2,3 SA older adults are particularly affected by these barriers, yet these individuals are those who require CRC screening most, due to the increased CRC risks among older individuals. These older adults are in need of effective educational interventions to increase their knowledge on CRC screening, its benefits and how screening services can be accessed.

To educate SA effectively, we developed and implemented a family-based multimedia educational intervention, and assessed its effectiveness in promoting FIT utilisation among SA older adults in a cluster-randomised controlled trial. The intervention not only provides education on FIT to the SA older adults, but also highlights the importance of support from younger family members in enhancing cancer screening utilisation among these adults. It involved a multimedia health talk by trained instructors and navigational assistance by site coordinators, where they accompanied the older adults to attend medical appointment with a family doctor for FIT. Dyad participants, comprising an older adult and one of their younger family members, were recruited among SA communities through our partnerships with non-governmental organisations (NGOs).

The intervention appeared effective in enhancing FIT utilisation among SA older adults, as the proportion of intervention participants having undergone FIT was 10 times higher than that among control participants. Among the younger family members, the intervention may have promoted their level of willingness and readiness to encourage and assist their older family members to undergo FIT, where such levels had remained high at post-intervention among the dyads in the intervention group only. Moreover, the participants were satisfied with the intervention, expressing that they would promote it to their peers. Over 80% of our partnering NGOs were impressed with the intervention and would continue implementing it at their centres provided they have the manpower and resources. Overall, our findings demonstrated the acceptability and effectiveness of our family-based multimedia intervention, and the potential feasibility of its implementation in local SA communities.

Given the demonstrated effectiveness of the intervention in promoting CRC screening utilisation among local SA, we suggest that the intervention should be implemented regularly within SA communities worldwide, via NGOs serving local SA. Governments worldwide may allocate more resources for training the staff at these NGOs, enhancing their competence in delivering the intervention to their community peers. With enhanced awareness of SA on the importance of CRC screening and prevention, it is of potential that the CRC prevalence among this disadvantaged population group in regions worldwide can be reduced.

Detailed report of this study can be found in the published article in the International Journal of Nursing Studies.4


References

1.    Choi KC, So WK, Chen JM, Lau GC, Lee PC, Chan CW. Comparison Study of Uptake of Colorectal Cancer Testing between Ethnic Minorities and the General Population in Hong Kong. Asian Pac J Cancer Prev. 2015; 16(17): 7713-7720. http://dx.doi.org/10.7314/apjcp.2015.16.17.7713.

2.    Campbell C, Douglas A, Williams L, Cezard G, Brewster DH, Buchanan D, Robb K, Stanners G, Weller D, Steele RJ, Steiner M, Bhopal R. Are there ethnic and religious variations in uptake of bowel cancer screening? A retrospective cohort study among 1.7 million people in Scotland. BMJ Open. 2020; 10(10): e037011. http://dx.doi.org/10.1136/bmjopen-2020-037011.

3.    Wyatt LC, Patel S, Kranick JA, Raveis VH, Ravenell JE, Yi SS, Kwon SC, Islam NS. Disparities in colorectal cancer screening among South Asians in New York City: a cross-sectional study. J Cancer Educ. 2021: http://dx.doi.org/10.1007/s13187-021-01991-7.

4.    So WKW, Chan DNS, Law BMH, Choi KC, Krishnasamy M, Chan CWH. Effect of a family-based multimedia intervention on the uptake of faecal immunohistochemical test among South Asian older adults: A cluster-randomised controlled trial. Int J Nurs Stud. 2022; 132: 104254. https://doi.org/10.1016/j.ijnurstu.2022.104254

The flow of the family-based multimedia intervention project. In this project, we first recruited a number of South Asian instructors who will take part in delivering the educational intervention to their community peers. They were trained on their presentation skills and educated on various aspects of colorectal cancer and its prevention. They were also given training on how stool sample is collected for faecal immunohistochemical test (FIT). They were given a competence assessment at the end of the training. Upon passing the assessment, they will be engaged in delivering the family-based multimedia intervention. The intervention involved a health talk on colorectal cancer, colorectal cancer screening and how it can be accessed. During the talk, a video clip was shown, with its content highlighting the importance of support from younger family members in modifying cancer screening behaviours of the older participants. A demonstration on how stool sample is collected for FIT was also given by the instructor during the talk. Finally, each participant received a health information booklets at the end of the talk, with the contents aiming to reinforce the knowledge gained by the participants during the educational intervention.