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Heterogeneous Demographic and Cultural Profiles of Chinese American Patients Nonadherent to Colorectal Cancer Screening: A Latent Class Analysis

Strong, Carol PhD; Ji, Cheng Shuang PhD; Liang, Wenchi PhD; Ma, Grace PhD; Brown, Roger PhD; Wang, Judy Huei-yu PhD

doi: 10.1097/NCC.0b013e3182888b5b

Background: Colorectal cancer (CRC) is one of the leading causes of cancer death in Chinese Americans, but their CRC screening rates remain low.

Objective: We examined subgroups of Chinese American patients nonadherent to CRC screening guidelines to better inform clinical practices to effectively promote screening.

Methods: Using latent class analysis of data from 327 participants recruited from 18 primary care clinics, we classified nonadherent patients based on sociodemographics, screening barriers, and attitudinal and clinical factors for CRC screening.

Results: The best-fitting latent class analysis model described 3 distinctive classes: Western healthcare class (36%), Eastern healthcare class (18%), and mixed healthcare class (46%). Western healthcare class patients were highly educated, with average US residency of 20 years, a high level of English proficiency, the least Eastern cultural views of care, and the greatest exposure to physician recommendations, but reported having no time for screenings. Eastern healthcare class patients were highly educated seniors and recent immigrants with the least CRC knowledge and the most Eastern cultural views. Mixed healthcare class patients had low level of education, resided in the United States for 20 years, and half had sought services of their physicians for at least 3 years, but their knowledge and cultural views were similar to those of Eastern healthcare class patients.

Conclusions: Nonadherent Chinese American patients are heterogeneous. It is essential to have future intervention programs tailored to address specific screening beliefs and barriers for subtypes of nonadherent patients.

Implications for Practice: Training primary care physicians to recognize patients’ different demographic characteristics and healthcare beliefs may facilitate physicians’ communication with patients to overcome their barriers and improve screening behaviors.

Author Affiliations: Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Strong); Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (Drs Ji, Liang, and Wang); Department of Public Health and Center for Asian Health, Temple University, Philadelphia, Pennsylvania (Dr Ma); and School of Nursing, University of Wisconsin–Madison (Dr Brown).

Funding for this study was provided by National Cancer Institute grants R01 CA121023. The National Cancer Institute had no further role in study design, data collection, analysis, interpretation, the writing of the report, or in the decision to submit the paper for publication.

The authors have no conflicts of interest to disclose.

Correspondence: Judy Huei-Yu Wang, PhD, Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center; Suite 4100, 3300 Whitehaven St, NW, Washington, DC 20007 (

Accepted for publication December 21, 2012.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins