CE Presentation Lesley

8/14/2019 CE Presentation Lesley

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Formative Research Towards the Design and Implementation of

an Effective Hepatitis B Screening Program for

Chinese Americans in Montgomery County, Maryland

Sau Kuen Lesley Fung

MPH in Health Promotion Candidate

School of Public Health and Health Services

The George Washington University

December 11, 2009


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Overview

Hepatitis B Background

The Research Project

Background

Goals and Objectives

Methods

Results and Discussion

Recommendations Questions


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Hepatitis B

Caused by infection with the hepatitis B virus (HBV)

The hepatitis B virus is 50 to 100 times more infectious than HIV

Acute and chronic

Chronic hepatitis B can lead to cirrhosis, liver function failure, and liver cancer

The virus is transmitted through contact with the blood or other body fluids of aninfected person

Source: World Health Organization. (2009). Hepatitis B. Retrieved 1 August, 2009, from http://www.who.int/mediacentre/factsheets/fs204/en/
http://www.who.int/mediacentre/factsheets/fs204/en/http://www.who.int/mediacentre/factsheets/fs204/en/


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Hepatitis B

Globally, >350 million people are living with chronic infection. About 78%of chronically infected people live in Asia or the Pacific Islands.

Hepatitis B is severe particularly in countries in Asia WHO recognizeshepatitis B as endemic in China

In the US, about 1.4 million people are chronically infected with HBV andover half of them are Asian Americans and Pacific Islanders (AAPIs)

About 60,000 people become infected with HBV each year

Liver cancer is the 3rd most common cause of cancer of death in AAPIsand almost 80% of the illness is attributable to the development of HBV

Sources:

World Health Organization. (2009). Hepatitis B. Retrieved 1 August, 2009, from http://www.who.int/mediacentre/factsheets/fs204/en/

Hepatitis B Foundation. (2009). Hepatitis B and Primary Liver Cancer. Retrieved 1 August, 2009, from http://www.hepb.org/professionals/hepb_and_liver_cancer.htm
http://www.who.int/mediacentre/factsheets/fs204/en/http://www.hepb.org/professionals/hepb_and_liver_cancer.htmhttp://www.hepb.org/professionals/hepb_and_liver_cancer.htmhttp://www.hepb.org/professionals/hepb_and_liver_cancer.htmhttp://www.hepb.org/professionals/hepb_and_liver_cancer.htmhttp://www.who.int/mediacentre/factsheets/fs204/en/


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Hepatitis B

Asian Americans are 3-13 times more likely to die from liver cancer caused by

HBV than any other racial/ethnic groups

1 out of 10 AAPIs is chronically infected with HBV vs 1 out of 1,000 of Caucasians

Eliminating health disparities is one of the over-arching goals of Healthy People2010

Incidence & prevalence rates are high given AAPIs only comprise 5% of the totalUS population

Need to implement a prevention program to reduce the health disparities inhepatitis B among Asian Americans

Asians are the 2nd fastest-growing minority group after Hispanics in US; Chinese is

the largest subgroup of the Asian Americans; Chinese Americans population isone of the highest at-risk communities for HBV infection. Research is essential tounderstand the needs of this group.

Sources:National Cancer Institute. (2009). Surveillance, epidemiology, and end results. Fast stats. Retrieved August 1, 2009, from http://seer.cancer.gov/faststats/selections.php#OutputStanford University Asia Liver Center. (2009). FAQ about hepatitis B. Retrieved August 1, 2009, from http://liver.stanford.edu/Education/faq.htmlU.S. Census Bureau. (2009). News Room: Facts for Features. Retrieved 1 August, 2009, from

http://www.census.gov/Press-Release/www/releases/archives/facts_for_features_special_editions/004522.htmlHealthy People 2010. (2009). What is Healthy People 2010? Retrieved August 2, 2009, from http://www.healthypeople.gov/About/hpfact.htm
http://seer.cancer.gov/faststats/selections.phphttp://liver.stanford.edu/Education/faq.htmlhttp://www.census.gov/Press-Release/www/releases/archives/facts_for_features_special_editions/004522.htmlhttp://www.census.gov/Press-Release/www/releases/archives/facts_for_features_special_editions/004522.htmlhttp://liver.stanford.edu/Education/faq.htmlhttp://liver.stanford.edu/Education/faq.htmlhttp://seer.cancer.gov/faststats/selections.php


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Research Project - Background

Montgomery County Department of Health and Human Services of Marylandidentifies hepatitis B as one of the health issues which they committed toimprove under the Asian American Health Initiative (AAHI)

Planned to implement a hepatitis B screening program for the AsianAmericans in Montgomery County

Asian Americans population has grown 62% from 1990 to 2006 inMontgomery County. Chinese Americans are the largest subgroup (30%) Focus of study of this project

Source:

Asian American Health Initiative, Montgomery County Department of Health and Human Services. (2008). Asian American healthpriorities: Strengths, needs, and opportunities for action A study of Montgomery County, Maryland. Retrieved July 9, 2009,from http://www.aahiinfo.org/english/programs/needsAssesment.php
http://www.aahiinfo.org/english/programs/needsAssesment.phphttp://www.aahiinfo.org/english/programs/needsAssesment.phphttp://www.aahiinfo.org/english/programs/needsAssesment.php


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Research Project - Goals

Health Goal To reduce liver diseases attributable to hepatitis B infection among Chinese

Americans in Montgomery County, Maryland

Behavioral Goal

To maximize participation rate in hepatitis B screening of ChineseAmericans in Montgomery County, Maryland

Project Goal To conduct research that will inform the Asian American Health Initiative of

the Montgomery County Department of Health and Human Servicesconcerning the effective design and implementation of a hepatitis Bscreening program for the Chinese Americans in Montgomery County


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Research Project - Objectives

1. To assess the knowledge of hepatitis B among Chinese Americans in MontgomeryCounty, Maryland

2. To understand the attitudes toward hepatitis B among Chinese Americans inMontgomery County, Maryland

3. To identify the motivations for hepatitis B screening of Chinese Americans inMontgomery County

4. To identify the barriers to hepatitis B screening of Chinese Americans in MontgomeryCounty

5. To identify possible communication channels for the promotion of the hepatitis Bscreening program


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Research Project - MethodsStudy Population

23 male and 26 female Chinese American adults (aged 27-77), living inMontgomery County of Maryland

Recruited through selected community-based (CBO) and faith-based (FBO)organizations in the County

Eligibility: had not participated in hepatitis B screening before Taiwanese belongs to the Other Asian subgroup excluded from the study

Focus Group 8 focus groups were conducted separately according to gender (male or

female) and language (Cantonese or Mandarin) Focus group sessions were audiotaped Responses collected were analyzed by using coding

Theoretical Framework Health Belief Model Questions of focus group guide were framed according to the 6 constructs:

perceived susceptibility, perceived severity, perceived benefits,

perceived barriers, cues to action, and self-efficacy


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Research Project Results & Discussion

Participant Characteristics Comparatively older: 37% aged 40-50 yrs; 61% over 50 yrs old

Highly educated: 57% had a university or higher educational level; 33% with an educationallevel of up to high school

Number of Years lived in US: 1-41 years; 47% over 20 years

English language: 43% - fair; 39% - fluent; 18% - poor/didnt know English at all

Health insurance status: 80% had health insurance (49% provided by employers, 31% privateinsurance, 21% Medicare)


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Knowledge of Hepatitis B

Heard of hepatitis B

Seldom heard about it in the US

May reflect not enough health education and/or ineffective health communications with

regard to hepatitis B or hepatitis in general

Lack of hepatitis B knowledge

I have heard a lot about cancer, heart disease, AIDS, and swine flu lately, but I seldom heard about hepatitis

B in here. Cantonese speaking male participant

I heard about hepatitis, I know there are different types, I have no idea what the differences are. I always think

hepatitis B is transmitted through contaminated foods.Cantonese speaking female participant


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Perceived Susceptibility & Perceived Severity Females and older participants tended to worry more about getting

hepatitis B Young male participants seemed to have very low perceived

susceptibility Hepatitis B is a serious diseaseburden to the family

Perception affected by lack of accurate knowledge overreaction oroverlooking

Yes, I worried about getting the disease because I know some people who have the disease. Mandarinspeaking female participant

I never thought of getting the disease. I worried about having a car accident more than getting liverdisease.

Cantonese speaking male participant

Its very troublesome if one has hepatitis B. You need to be very careful in your daily living. You need toseparate all the household utensils; otherwise, its easy to transmit the disease to your family membersCantonese speaking female participant

I dont exactly know how severe the disease is. If just by looking at the name, it doesnt seem serious to me;it looks as if its related to inflammation. It is not like cancer which can take your life I dont know.



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Perceived Benefits Positive attitudes towards screening

Prevention not only to themselves but also to their families

Early detection; peaceful mind

I think its good to go take the test because you will know your status. If you know you have the virus, you know you

have to be careful, you dont want to transmit it to your family members.

Mandarin speaking male participant

Its for prevention. But I have annual physical check-up and the results showed that my liver functions were normal.

Do I still need to take a separate test?Cantonese speaking male participant


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Perceived Barriers to Screening

Older people tended to face more barriers

Barriers: no health insurance, cost, English language barrier, limited access totransportation, and lack of information

I dont have health insurance; I cannot communicate in English and I dont know how to drive.

Mandarin speaking male participant

Even though I have the insurance, I am not sure if the screening will be covered; if the cost is too high, I may not consider taking itbecause with the amount of money, I can do other things. There is no urgency for me to do it. Cantonese speaking femaleparticipant

To me, the only barrier is that I dont have enough information about hepatitis B, I need more information to understand the wholepicture. I have ever thought of going to take a blood test simply because I dont know that there is a need to do so.Cantonesespeaking male participant


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Cues to Action

Physicians recommendation

Family members health

Male participants: would not go take a test until they felt sick

I always listen to the doctors; I will go take the test if the doctor tells me to do so.


Basically, I dont think I will take the initiation to take the test, but if the doctor advise me to do that and the disease will affect my family, say, my kids, I will definitely go take the test.


I will only go take a test until I dont feel well. Mandarin speaking male participant


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Self-efficacy

In general, participants believed that they had the confidence and ability to participate in Hepatitis B screening

More information enhanced decision on taking the test, more confidence to solve the barriers

Older people: less confidence

I had the confidence to solve the barriers and go take the test if I understand that there are serious consequences of getting the disease. I willtry my best to solve the barriers, I believe I can do it. Cantonese speaking female participant

I dont have the confidence. I dont think I can solve the problems especially talking about language barriers. For example, once the doctortold me that I might have prostate problem. He asked me to go somewhere else to see another doctor, I didnt know how to go there and Ijust left it. I live with my daughter, she has to work and she is not good at English. What can I do? I dont know English. When I didnt feelwell, I wouldnt say it out. There is nothing I can do.Cantonese speaking male participant


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Limitations of the Study1. Findings limited to the segment of population comparatively older,

highly educated, and comparatively active

2. Purposive sampling, self-selected volunteers not a representative

sample of the Chinese Americans in the whole Montgomery County;did not represent other Asian Americans

3. Eligibility of participants should not have been screened before;however, no attempt was made to verify their screening status in thisstudy

4. Coding and data analysis might have bias


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Research Project Recommendations

1. Increase the awareness and knowledge of hepatitis B among ChineseAmericans

2. Emphasize the benefit of screening not only to the individual but alsoto their family members

3. Connect with physicians to utilize their influence on participants topromote the screening program

4. Highlight in the screening promotional materials that

the hepatitis B virus blood test is not included in the annual routine

physical check-up A normal liver function result does not necessarily mean the

person is not a HBV carrier


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Research Project Recommendations

5. Work with community-based and faith-basedorganizations

6. Provide clear and readily available information

regarding post-screening follow up actions

7. Conduct further research to embrace opinions from

younger/ lower socio-economic status/ non-CBO and

non-FBO Chinese Americans (Restaurant workers area group worth exploring)


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THANK YOU!

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CE Presentation Lesley