1
|
Zovich B, Block SJ, Borondy-Jenkins F, Chen T, Moraras K, Afoakwah J, Dong M, Cohen C. The Role of Culturally Appropriate Mediated Communication Strategies to Reduce Hepatitis B and Liver Cancer Disparities. JOURNAL OF HEALTH COMMUNICATION 2024:1-10. [PMID: 38832597 DOI: 10.1080/10810730.2024.2362882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Asian, Pacific Islander, African, and Caribbean communities in the U.S. are heavily impacted by chronic hepatitis B (HBV) and hepatocellular carcinoma (HCC). Educating these groups about the link between the two diseases is imperative to improve screening rates and health outcomes. This study aims to identify and incorporate preferred mediated communication methods into community-specific educational campaigns which emphasize the connection between the conditions, to promote uptake of prevention and management behaviors for HBV and HCC. Fifteen focus groups and two key informant interviews were conducted with Micronesian, Chinese, Hmong, Nigerian, Ghanaian, Vietnamese, Korean, Somali, Ethiopian, Filipino, Haitian, and Francophone West African communities. Data were analyzed using thematic coding and analysis. Findings demonstrate that all communities preferred materials be offered in both English and native languages and requested that materials highlight the connection between HBV and HCC. Delivery channel preferences and messaging themes varied by group. This study provides insight into community-specific preferences for learning about HBV and HCC. The findings can be used to design culturally and linguistically tailored, multi-platform, health education campaigns to facilitate improved HBV screening and vaccination rates and increase knowledge about HCC risk among highly impacted communities in the U.S.
Collapse
Affiliation(s)
- Beatrice Zovich
- Public Health Research, Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Suzanne J Block
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Thomas Chen
- Department of Internal Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Kate Moraras
- Public Health Research, Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Janet Afoakwah
- Public Health Research, Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Mi Dong
- Public Health Research, Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Chari Cohen
- Public Health Research, Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| |
Collapse
|
2
|
Lee DU, Bhowmick K, Kolachana S, Schuster K, Bahadur A, Harmacinski A, Schellhammer S, Fan GH, Lee KJ, Sun C, Chou H, Lominadze Z. Inpatient Cost Burdens of Treating Chronic Hepatitis B in US Hospitals: A Weighted Analysis of a National Database. Dig Dis Sci 2024:10.1007/s10620-024-08448-z. [PMID: 38658506 DOI: 10.1007/s10620-024-08448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS This study evaluates the cost burdens of inpatient care for chronic hepatitis B (CHB). We aimed to stratify the patients based on the presence of cirrhosis and conduct subgroup analyses on patient demographics and medical characteristics. METHODS The 2016-2019 National Inpatient Sample was used to select individuals diagnosed with CHB. The weighted charge estimates were derived and converted to admission costs, adjusting for inflation to the year 2016, and presented in United States Dollars. These adjusted values were stratified using select patient variables. To assess the goodness-of-fit for each trend, we graphed the data across the respective years, expressed in a chronological sequence with format (R2, p-value). Analysis of CHB patients was carried out in three groups: the composite CHB population, the subset of patients with cirrhosis, and the subset of patients without cirrhosis. RESULTS From 2016 to 2019, the total costs of hospitalizations in CHB patients were $603.82, $737.92, $758.29, and $809.01 million dollars from 2016 to 2019, respectively. We did not observe significant cost trends in the composite CHB population or in the cirrhosis and non-cirrhosis cohorts. However, we did find rising costs associated with age older than 65 (0.97, 0.02), white race (0.98, 0.01), Hispanic ethnicity (1.00, 0.001), and Medicare coverage (0.95, 0.02), the significance of which persisted regardless of the presence of cirrhosis. Additionally, inpatients without cirrhosis who had comorbid metabolic dysfunction-associated steatotic liver disease (MASLD) were also observed to have rising costs (0.96, 0.02). CONCLUSIONS We did not find a significant increase in overall costs with CHB inpatients, regardless of the presence of cirrhosis. However, certain groups are more susceptible to escalating costs. Therefore, increased screening and nuanced vaccination planning must be optimized in order to prevent and mitigate these growing cost burdens on vulnerable populations.
Collapse
Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA.
| | - Kuntal Bhowmick
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Sindhura Kolachana
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Kimberly Schuster
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Aneesh Bahadur
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Ashton Harmacinski
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Sophie Schellhammer
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Gregory Hongyuan Fan
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Ki Jung Lee
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Catherine Sun
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Hannah Chou
- Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA
| | - Zurabi Lominadze
- Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA
| |
Collapse
|
3
|
Gray C, Porter G, Lobo R, Crawford G. Development and evaluation of health education resources for culturally and linguistically diverse populations: a systematic review. HEALTH EDUCATION RESEARCH 2024; 39:102-118. [PMID: 36994771 DOI: 10.1093/her/cyad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/13/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
People from culturally and linguistically diverse (CaLD) backgrounds in Australia generally experience poorer health outcomes, explained in part by low levels of health literacy. We conducted a systematic review to examine the development and evaluation of health education resources designed for CaLD populations. Five electronic databases were searched for English language, peer-reviewed studies published between 1980 and 2020. Thirty-four studies met the inclusion criteria. Twenty-four different health education resources were described and broadly categorized into four types: media campaigns (n = 10), text-based materials (n = 5), films (n = 8) and radio (n = 1). Studies were assessed against domains adapted from a health literacy guideline incorporating: need, collaboration, audience, health literacy, theory, test and process and impact evaluation. All but one study met the majority of the domains. All studies reported positive evaluation outcomes; this may be due to studies involving community early in resource design and including health literacy considerations in their design. Reporting resource design and evaluation against standard practice controls is recommended to build a more robust evidence base for developing effective health education resources for use by audiences from CaLD backgrounds.
Collapse
Affiliation(s)
- Corie Gray
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Georgia Porter
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Roanna Lobo
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Gemma Crawford
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| |
Collapse
|
4
|
Gnyawali B, Pusateri A, Nickerson A, Jalil S, Mumtaz K. Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma. World J Gastroenterol 2022; 28:3793-3802. [PMID: 36157533 PMCID: PMC9367226 DOI: 10.3748/wjg.v28.i29.3793] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/10/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Chronic Hepatitis B is a highly prevalent disease worldwide and is estimated to cause more than 800000 annual deaths from complications such as cirrhosis and hepatocellular carcinoma (HCC). Although universal hepatitis B vaccination programs may have reduced the incidence and prevalence of chronic hepatitis B and related HCC, the disease still imposes a significant healthcare burden in many endemic regions such as Africa and the Asia-Pacific region. This is especially concerning given the global underdiagnosis of hepatitis B and the limited availability of vaccination, screening, and treatment in low-resource regions. Demographics including male gender, older age, ethnicity, and geographic location as well as low socioeconomic status are more heavily impacted by chronic hepatitis B and related HCC. Methods to mitigate this impact include increasing screening in high-risk groups according to national guidelines, increasing awareness and health literacy in vulnerable populations, and developing more robust vaccination programs in under-served regions.
Collapse
Affiliation(s)
- Bipul Gnyawali
- Department of Medicine, Kettering Medical Center, Dayton, OH 45342, United States
| | - Antoinette Pusateri
- Department of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Ashley Nickerson
- Department of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Sajid Jalil
- Department of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Khalid Mumtaz
- Department of Medicine, The Ohio State University, Columbus, OH 43210, United States
| |
Collapse
|
5
|
Halvorsrud K, Eylem O, Mooney R, Haarmans M, Bhui K. Identifying evidence of the effectiveness of photovoice: a systematic review and meta-analysis of the international healthcare literature. J Public Health (Oxf) 2021; 44:704-712. [PMID: 33823022 PMCID: PMC9424055 DOI: 10.1093/pubmed/fdab074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/20/2021] [Accepted: 02/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background Photovoice (PV) was conceptualized in the early 1990s to engage community members in capturing/communicating their lived experience narratives through photography. However, no meta-analyses in health research have assessed whether PV achieves its purported effects. Methods We carried forward any relevant references from a previous review identifying PV studies before 2008 and searched MEDLINE, Embase, PsycINFO and Cochrane Central Register of Controlled Trials from 2008 up until October 2019. We included both published and grey literature, in any population or context. We assessed quality with the Effective Public Health Practice Project’s (EPHPP) tool and pooled studies using the standardized mean difference (SMD) and 95% confidence intervals (CIs). Results Twenty-eight studies were included, showing significant post-treatment effects only for health knowledge (SMD, 95% CIs = 0.41, 0.09 to 0.73, n = 16) and community functions (SMD, 95% CIs = 0.22, 0.03 to 0.40, n = 4). Strong heterogeneity was indicated for health knowledge, potentially explained by a larger effect in ethnic minority populations. There was insufficient follow-up data for health knowledge, while in follow-up for community functions the post-treatment effect was lost. Conclusions PV’s post-treatment effect on health knowledge did not translate into positive health behaviours or physical and mental health outcomes, longer-term community functions, or health service outcomes.
Collapse
Affiliation(s)
- Kristoffer Halvorsrud
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.,NIHR ARC North Thames, Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Ozlem Eylem
- Centre for Psychiatry, Queen Mary University of London, London, EC1M 6BQ, UK.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Roisin Mooney
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Maria Haarmans
- Sociology, School of Social Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| |
Collapse
|
6
|
Hyun S, Ko O, Kim S, Ventura WR. Sociocultural barriers to hepatitis B health literacy in an immigrant population: a focus group study in Korean Americans. BMC Public Health 2021; 21:404. [PMID: 33632203 PMCID: PMC7908637 DOI: 10.1186/s12889-021-10441-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/15/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic hepatitis B (CHB) is a major global health issue disproportionately affecting Asian Americans and other immigrant populations in the United States. Despite the high risk of morbid complications from CHB, the majority of individuals with CHB do not access healthcare due to a complex of barriers. These barriers influence health literacy which may affect behaviors linked to hepatitis B care. We aimed to identify and evaluate various sociocultural factors and how they interact with health literacy to impact CHB care and health seeking in a Korean American population. METHODS A total of 28 Korean American individuals with CHB were divided into 5 different focus discussion groups. This study investigated the participants' sociocultural backgrounds as well as their awareness and utilization of the healthcare system that could influence their health literacy and behaviors in accessing care. RESULTS Our analysis identified and concentrated on three themes that emerged from these discussions: low risk perception and knowledge of CHB and its complications; language, immigrant status, and stigma; and financial and institutional barriers. The participants' overall awareness of the disease and prevention methods demonstrated poor understanding of important characteristics and potential outcomes of the disease. Additionally, differences in cultural expectations and a lack of understanding and utilization of healthcare systems affected health literacy in further limiting participants' motivation to seek care. CONCLUSIONS The present study suggests that there are culture-specific barriers to health literacy governing individuals' health behavior in accessing hepatitis B care. These findings may inform strategies for developing culturally tailored resources and programs and for facilitating the implementation of community-wide hepatitis B education and screening initiatives in immigrant communities.
Collapse
Affiliation(s)
- Sarah Hyun
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10964 USA
| | - Okhyun Ko
- KCS Public Health and Research Center, 2 W. 32nd St. Suite 604, New York, NY 10001 USA
| | - Soonsik Kim
- KCS Public Health and Research Center, 2 W. 32nd St. Suite 604, New York, NY 10001 USA
| | | |
Collapse
|
7
|
Kaur N, Kandelman D, Potvin L. Development and pilot testing of an oral hygiene self-care photonovel for Punjabi immigrants: a qualitative study. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2021; 55:30-38. [PMID: 33643415 PMCID: PMC7906123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 06/26/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The purpose of this research study was to develop and pilot test a culturally and linguistically appropriate oral hygiene self-care photonovel for Punjabi immigrants. METHODS Purposeful sampling technique was used to recruit 5 members of a Punjabi community organization (the Sikh Women's Association of Montreal) for participation in 3 focus group sessions in August 2015. A thematic content analysis approach was used to sort the data, enabling identification of the storyline and photonovel contents from the themes that emerged. Comic Life 3 version 3.1.1 software was used to create a "Safeguard Your Smile" (SYS) photonovel, which was printed for pilot testing. Ten additional participants were recruited for this pilot testing, enabling further revision of the photonovel based on their suggestions. RESULTS Four major themes emerged from the focus group discussions: 1) lack of understanding of oral hygiene self-care and risk factors; 2) lack of oral hygiene self-care-related awareness and routine; 3) lack of emphasis on prevention by oral health care providers; and 4) perceived barriers to accessing dental health care. Thematic content analysis revealed a lack of knowledge of oral hygiene self-care skills and routine. Guided by these overarching themes, a final version of the photonovel script was created including photographs of key characters. The photonovel was subsequently printed for pilot testing. Pilot test results revealed close to 80% of participants agreed that the SYS photonovel was culturally and linguistically appropriate and easy to understand. CONCLUSIONS A culturally and linguistically appropriate photonovel may be a useful tool for enhancing oral hygiene self-care knowledge among ethnic communities. Further studies are required to test the effectiveness of such a tool.
Collapse
Affiliation(s)
- Navdeep Kaur
- Research associate, Unité de recherche en psychiatrie des toxicomanies, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal,
QC, Canada
| | - Daniel Kandelman
- Associate professor, Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Louise Potvin
- Canada Research Chair, Community Approaches and Health Inequalities; Scientific director, Centre de recherche en santé publique, Université de Montréal; Centre
intégré universitaire de santé et services sociaux du Centre-sud-de-l’île-de-Montréal, Montreal, QC, Canada
| |
Collapse
|
8
|
Kaur N. Impact of photonovel interventions among people with low levels of health literacy: A literature review. EDUCATION FOR INFORMATION 2019. [DOI: 10.3233/efi-180212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
9
|
Abstract
This study evaluated the effects of a health-related fotonovela about crystal meth (S-methamphetamine hydrochloride) among "Colored" people (an ethnic label for people of mixed race) in the Western Cape province of South Africa. Crystal meth use is most common among Colored people in this province and it is considered a major social problem. The fotonovela was compared to a no-message control group and a traditional brochure in a randomized controlled trial (N = 303). The fotonovela outperformed the control condition for knowledge level and it outperformed the traditional brochure on intention toward starting conversations about crystal meth. Especially readers with relatively low levels of education clearly preferred the fotonovela over the traditional brochure.
Collapse
Affiliation(s)
- Burt Davis
- Africa Centre for HIV/AIDS Management, Stellenbosch University, Stellenbosch, South Africa
| | - Carel Jansen
- University of Groningen, Faculty of Arts, Communication and Information Studies, Groningen, the Netherlands.,Language Centre, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
10
|
Gowin M, Wilkerson A, Maness S, Larson DJ, Crowson HM, Smith M, Cheney MK. Wearable Activity Tracker Use in Young Adults Through the Lens of Social Cognitive Theory. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2018.1548314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
11
|
Raoofi A, Hatefnia E, Kazemnejad A. Helping to prevent hepatitis B in family setting, by educating women to vaccinate before marriage. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:354-365. [PMID: 30004828 DOI: 10.1080/19371918.2018.1487358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hepatitis B (HB) is one of the major public health problems and a major cause of liver cirrhosis and hepatocellular carcinoma (HCC). The aim of this study was to evaluate the effect of a model-based educational intervention on preventive health behavior of hepatitis B vaccination among women who were going to get married (pending marriage women). Seventy pending marriage women were selected from martial counseling centers. The participants' knowledge, health beliefs model (HBM) constructs, and intention to receive HB vaccination were collected using a questionnaire based on HBM. The questionnaire was based on the Likert-type scale with the score range of 1 to 5. An educational intervention was carried out based on pretest results. The baseline and follow-up level of the variables was statistically significant within the case group. The mean score of the variables in the two groups showed a statistically significant difference in favor of the case group. Our study showed a positive effect of educational intervention on the participants' knowledge, HBM constructs, and intention to receive HB vaccination, indicating that educational intervention based on HBM could be used as an appropriate tool to improve preventive behavior of HB vaccination.
Collapse
Affiliation(s)
- Azam Raoofi
- a Department of Health Education and Promotion, School of Public Health , Alborz University of Medical Sciences , Karaj , Iran (the Islamic Republic of)
- b Medical Ethics Department , Breast Cancer Research Center, Motamed Cancer Institute, ACECR , Tehran , Iran (the Islamic Republic of)
| | - Effat Hatefnia
- c Social Determinants of Health Research Center , Alborz University of Medical Sciences , Karaj , Iran (the Islamic Republic of)
| | - Anoshirvan Kazemnejad
- d Department of Biostatistics, Faculty of Medical Sciences , Tarbiat Modares University , Tehran , Iran (the Islamic Republic of)
| |
Collapse
|
12
|
Hepatitis B Virus Infection and Exposure Among Foreign-Born Asian Americans in the U.S. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.43018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
13
|
Juon HS, Strong C, Kim F, Park E, Lee S. Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial. PLoS One 2016; 11:e0162683. [PMID: 27617742 PMCID: PMC5019387 DOI: 10.1371/journal.pone.0162683] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/24/2016] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to evaluate the effect of a lay health worker (LHW) telephone intervention on completing a series of hepatitis B virus (HBV) vaccinations among foreign-born Asian Americans in the Baltimore-Washington Metropolitan area. Methods During the period of April 2013 and March 2014, we recruited Asian Americans who were 18 years of age and older in the community-based organizations. Of the 645 eligible participants, 600 (201 Chinese, 198 Korean, 201 Vietnamese) completed a pretest survey and received hepatitis B screening. Based on the screening results, we conducted a randomized controlled trial among those unprotected (HBsAg-/HBsAB-) by assigning them either to an intervention group (n = 124) or control group (n = 108). The intervention group received a list of resources by mails for where to get free vaccinations as well as reminder calls for vaccinations from trained LHWs, while the control group received only list of resources by mail. Seven months after mailing the HBV screening results, trained LHWs followed up with all participants by phone to ask how many of the recommended series of 3 vaccinations they had received: none, 1 or 2, or all 3 (complete). Their self-reported vaccinations were verified with the medical records. Multinomial logistic regressions were used to examine the effect of the LHW intervention. Process evaluation was conducted by asking study participants in the intervention group to evaluate the performance of the LHWs. Results After seven months, those in the intervention group were more likely to have 1 or more vaccines than the control group, compared to the no vaccination group (OR = 3.04, 95% CI, 1.16, 8.00). Also, those in the intervention group were more likely to complete a series of vaccinations than the control group, compared to the no vaccination group (OR = 7.29, 95% CI 3.39, 15.67). The most important barrier preventing them from seeking hepatitis B vaccinations was lack of time to get the vaccination. The most important promoters to getting vaccinations, among those who had vaccinations (n = 89), were our intervention program (70.8%) and self-motivation (49.4%). The majority of participants in the intervention group received the phone calls from LHWs (93%) and almost all of them got the reminder to receive vaccines (98%). Conclusion The LHW intervention was successful at increasing HBV vaccinations rates among foreign-born Asian Americans. This study suggests that this culturally integrated intervention program may be useful for reducing liver cancer disparities from chronic HBV infection in high risk Asian Americans. Trial Registration ClinicalTrials.gov NCT02760537
Collapse
Affiliation(s)
- Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Frederic Kim
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Eunmi Park
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sunmin Lee
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, United States of America
| |
Collapse
|
14
|
Grootens-Wiegers P, de Vries MC, van Beusekom MM, van Dijck L, van den Broek JM. Comic strips help children understand medical research: targeting the informed consent procedure to children's needs. PATIENT EDUCATION AND COUNSELING 2015; 98:518-524. [PMID: 25612801 DOI: 10.1016/j.pec.2014.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 11/25/2014] [Accepted: 12/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Children involved in medical research often fail to comprehend essential research aspects. In order to improve information provision, a participatory approach was used to develop new information material explaining essential concepts of medical research. METHODS A draft of a comic strip was developed by a science communicator in collaboration with pediatricians. The draft was presented to children participating in a clinical trial and to two school classes. Children were consulted for further development in surveys and interviews. Subsequently, the material was revised and re-evaluated in four school classes with children of varying ages and educational levels. RESULTS In the first evaluation, children provided feedback on the storyline, wording and layout. Children thought the comic strip was 'fun' and 'informative'. Understanding of 8 basic research aspects was on average 83% and all above 65%, illustrating that children understood and remembered key messages. CONCLUSION A comic strip was developed to support the informed consent process. Children were consulted and provided feedback. The resulting material was well understood and accepted. PRACTICE IMPLICATIONS Involving children in the development of information material can substantially contribute to the quality of the material. Children were excited to participate and to 'be a part of science'.
Collapse
Affiliation(s)
| | - Martine C de Vries
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mara M van Beusekom
- Department of Science Communication & Society, Leiden University, Leiden, The Netherlands
| | - Laura van Dijck
- Department of Science Communication & Society, Leiden University, Leiden, The Netherlands
| | - Jos M van den Broek
- Department of Science Communication & Society, Leiden University, Leiden, The Netherlands
| |
Collapse
|
15
|
Juon HS, Lee S, Strong C, Rimal R, Kirk GD, Bowie J. Effect of a liver cancer education program on hepatitis B screening among Asian Americans in the Baltimore-Washington metropolitan area, 2009-2010. Prev Chronic Dis 2014; 11:130258. [PMID: 24503341 PMCID: PMC3921910 DOI: 10.5888/pcd11.130258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Asian Americans have the highest incidence of hepatocellular carcinoma (HCC), the major form of primary liver cancer, of all ethnic groups in the United States. Chronic hepatitis B virus (HBV) infection is the most common cause of HCC, and as many as 1 in 10 foreign-born Asian Americans are chronically infected with HBV. We tested the effectiveness of a culturally tailored liver cancer education program for increasing screening for HBV among Chinese, Korean, and Vietnamese Americans residing in the Baltimore-Washington metropolitan area, from November 2009 through June 2010. METHODS We used a cluster randomized controlled trial to recruit volunteer participants from community-based organizations (CBOs) in the Baltimore-Washington metropolitan area. We selected 877 participants by using a pretest survey. People were eligible to participate if they had not attended a hepatitis B-related education program in the past 5 years. The intervention group (n = 441) received a 30-minute educational program, and the control group (n = 436) received an educational brochure. After attending the educational program, the intervention group completed a post-education survey. Six months later, participants in both groups were followed up by telephone. Receipt of HBV screening was the outcome measure. RESULTS Approximately 79% (n = 688) of participants completed the 6-month follow-up telephone survey. Among those who had not had HBV screening at baseline (n = 446), the adjusted odds of self-reported receipt of HBV screening at the 6-month follow-up to the educational program were significantly higher for the intervention group than for the control group (odds ratio = 5.13; 95% confidence interval, 3.14-8.39; P < .001). Chinese Americans and Vietnamese Americans had significantly higher odds of having HBV screening in the 6-month period than Korean Americans. CONCLUSION Culturally tailored education programs that increase liver cancer awareness can be effective in increasing HBV screening among underserved Asian American populations.
Collapse
Affiliation(s)
- Hee-Soon Juon
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 704, Baltimore, MD 21205. E-mail:
| | - Sunmin Lee
- University of Maryland School of Public Health, College Park, Maryland
| | - Carol Strong
- National Cheng Kung University, Tainan City, Taiwan
| | - Rajiv Rimal
- George Washington University, Washington, DC
| | | | | |
Collapse
|