A Community Health Worker-driven and integrated interactive text messaging intervention to promote smoking cessation and lung cancer screening uptake rates among high-risk Asian immigrants: a feasibility pilot RCT study

Abstract

Introduction: Lung cancer is a leading cause of cancer mortality among Asian-Americans. Despite the potential of lung cancer screening (LCS) to detect disease at an earlier stage and reduce mortality, the uptake of LCS remains low. This is particularly concerning among Asian subgroups with high smoking prevalence. Additionally, there are scarce intervention programs tailored specifically for Asian-Americans. The purpose of this pilot study was to develop and evaluate the Connect4LungHealth intervention to enhance LCS adoption and promote smoking cessation in high-risk Chinese and Korean communities via a Community-Health Worker (CHW)-driven approach integrated with mobile text messaging (TXT) strategies.

Methods: Connect4LungHealth intervention is a culturally sensitive, linguistically tailored program, facilitated by CHWs, collaboratively developed with our local Chinese and Korean community stakeholders to improve lung cancer control. Guided by our Community Advisory Board, LCS-eligible individuals were invited through community advertisements and social networks. Enrolled participants attended a Lung Health in-person workshop at a community setting and were then randomized to the Connect4LungHealth or an attention control (AC) group on the workshop level for a one-month intervention duration with a baseline, 1-month, and 3-month follow ups. Participants in the Connect4LungHealth arm received three tailored text messages per week, covering topics such as smoking cessation knowledge, self-regulatory skills, and raising LCS awareness with proactive CHW weekly check-in phone calls. The AC group received the same frequency of messages about healthy eating and was given information for connecting with CHW. Participants interested in LCS were directed to our institution's centralized LCS Program, supported by CHWs who could connect patients to insurance resources and accompany participants to an in-person shared decision-making visit performed by the LCS Program nurse navigator, followed immediately by a same-day low-dose CT (LDCT) scan.

Results: Among 48 LCS eligible community individuals we reached via community workshops, 36 (75%, 19 Chinese American and 17 Korean American) agreed, consented, and completed baseline assessment. Enrolled participants were randomized to the Connect4LungHealth (N=20) or the (AC) group (N=16). Participants were an average of 61 years old, 86.1% were males and 80.6% had education level of high school or below and 50% had limited English proficiency. The retention rate was above 75% with high satisfaction reported by the intervention participants. Although not statistically significant, potentially due to the small sample size, we observed a greater reduction in cigarette use and an increase in self-efficacy from baseline to 3-month follow-up in the Connect4LungHealth group compared to the AC group. Further, Connect4LungHealth group achieved a 40% LDCT completion rate via our institution's LCS Program, compared to a 12.5% completion rate in the AC group. Post-intervention interviews provided valuable insights into the cultural barriers and additional needs related to smoking cessation and navigational assistance, offering critical guidance for future program enhancements.

Conclusions: This pilot study showed the feasibility, acceptability, and potential impact of Connect4LungHealth intervention in improving LCS uptake and reducing cigarette use among high-risk Asian populations. Our integrated approach, utilizing mobile TXT combined with CHW model, is novel and highly relevant, and implementable in underserved communities. Future large-scale efficacy and implementation trials are needed to further validate these findings.

Keywords: Asian Americans; community health workers; lung cancer screening; smoking cessation; text messaging.