Family health history of colorectal cancer: a structural equation model of factors influencing Chinese Americans’ communication with family members

BACKGROUND: Chinese Americans, the largest subgroup of Asian Americans with a 63% of first-generation immigrants, suffer from high incidence and mortality rates of colorectal cancer (CRC). As an identification marker to classify the CRC risk level, family health history (FHH) of CRC can help physicians provide patients personalized recommendations towards CRC. Yet, Chinese Americans’ communication of FHH of CRC with family members is unknown. The purpose of this first-of-its-kind study is to examine Chinese Americans’ behavior and the associated psychological factors of FHH of CRC communication with family members. METHODS: We developed an integrated theoretical framework based on the Health Belief Model, the Theory of Planned Behavior, and the Social Cognitive Theory to assess Chinese Americans’ FHH of CRC communication with family members and the psychological factors affecting such communication behavior. Using structural equation modeling, the framework was tested with the baseline survey data from 742 Chinese American participants from a FHH-based CRC prevention program in Texas. RESULTS: The majority of Chinese American participants (with an average age of 47.7 years) were female (60.0%), married (72.0%), born outside the US (95.4%), did not speak English at home (95.5%), and had some kind of health insurance (75.2%). About half were employed (52.7%) and had college degrees or above (54.5%), some religious beliefs (52.5%), and primary care physicians (45.1%). Most Chinese Americans in our sample had either never or seldom collected and discussed with their family members about their FHH of CRC. The integrated theoretical framework was supported by the survey data. Perceived susceptibility for getting CRC, perceived severity for CRC, and perceived benefits of FHH of CRC communication with family members were significantly and positively associated with Chinese American participants’ attitudes toward FHH communication with family members (β =0.089, P<0.005; β =0.141, P<0.001; and β =0.479, P<0.001, respectively). Attitudes (β =0.324, P<0.001) and self-efficacy (β =0.577, P<0.001) in FHH of CRC communication were positively and significantly associated with the Chinese American sample’s intention in communicating FHH of CRC with their family members. Stronger intention, older age, lack of health insurance, and non-English spoken at home were correlated with participants’ behavior in FHH of CRC communication (β =0.410, P<0.001; β =0.113, P<0.05; β =−0.112, P<0.05; β =0.096, P<0.05, respectively). CONCLUSIONS: Given that most Chinese Americans in our sample lacked FHH of CRC communication with family members, interventions and education for this particular racial/ethnic population are needed. Our integrated theoretical framework may provide a guideline for such interventions and education in the future.