|
1
|
Ma GX, Zhu L, Tan Y, Zhai S, Ma X, Ogunwobi OO, Yang WJ, Ting T, Kim S, Wang MQ. A Comparative Trial of Improving Care for Underserved Asian Americans Infected with Hepatitis B Virus. Dig Dis Sci 2023; 68:2333-2343. [PMID: 36749506 DOI: 10.1007/s10620-023-07840-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/15/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC). Asian Americans have the highest incidence and mortality rates of HCC among all US racial/ethnic groups. Inadequate monitoring and treatment of chronic hepatitis B contribute to poor health outcomes and increased healthcare costs among Asian Americans. AIMS The goal of this study is to assess the effect of a patient-led strategy on chronic hepatitis B monitoring and treatment adherence specifically among Asian Americans with culturally tailored Patient Navigator-led Intervention. METHODS From 2015 to 2018, 532 eligible participants living with chronic hepatitis B in the greater Philadelphia and New York city metropolitan areas were randomly assigned to either the intervention group or the control group. Generalized linear mixed-effects models were used to estimate the odds ratio (OR) for rates of doctor visits for chronic hepatitis B and rates of alanine aminotransferase testing for evidence of liver damage. RESULTS Intervention group had higher rates of doctor visits than the control group at both 6-month (77.22% vs. 45.75%) and 12-month assessments (90.73% vs. 60.61%). Significantly more intervention group participants received ALT testing than control group participants at 6-month (52.90% vs. 25.10%) and 12-month (75.40% vs. 46.75%) follow-up. CONCLUSIONS Culturally and linguistically appropriate intervention has strong effects on adherence to follow-up care among Asian American hepatitis B patients experiencing challenges to medication adherence and follow up care. These findings further identify opportunities for practical implementation of evidence-based intervention that could lead to reductions in disparities in chronic liver disease and liver cancer among high-risk, underserved populations.
Collapse
Affiliation(s)
- Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Kresge Hall, Suite 320, 3440 N Broad St., Philadelphia, PA, 19140, USA. .,Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Kresge Hall, Suite 320, 3440 N Broad St., Philadelphia, PA, 19140, USA.,Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Kresge Hall, Suite 320, 3440 N Broad St., Philadelphia, PA, 19140, USA
| | - Shumenghui Zhai
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Xiaoli Ma
- Hepatology Clinic, Philadelphia, PA, USA
| | - Olorunseun O Ogunwobi
- Department of Biological Sciences, Hunter College, City University of New York, New York, NY, USA
| | - Wei Jenny Yang
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Kresge Hall, Suite 320, 3440 N Broad St., Philadelphia, PA, 19140, USA
| | - Tsunyou Ting
- Faith Hope Love Chinese Church, Philadelphia, PA, USA
| | - Sara Kim
- Korean Community Services of Metropolitan New York, New York, NY, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| |
Collapse
|
|
2
|
Ma GX, Zhu L, Lu W, Handorf E, Tan Y, Yeh MC, Johnson C, Guerrier G, Nguyen MT. Improving Long-Term Adherence to Monitoring/Treatment in Underserved Asian Americans with Chronic Hepatitis B (CHB) through a Multicomponent Culturally Tailored Intervention: A Randomized Controlled Trial. Healthcare (Basel) 2022; 10:1944. [PMID: 36292391 PMCID: PMC9601489 DOI: 10.3390/healthcare10101944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although Asian Americans make up 6% of the U.S. population, they account for 58% of Americans with chronic hepatitis B (CHB). Yet, adherence to monitoring and antiviral treatment guidelines among Asian American CHB patients remains suboptimal. METHODS The purpose of this study was to evaluate the efficacy of a multicomponent intervention on adherence to CHB monitoring among Asian Americans with CHB. The intervention components included virtual patient education, patient navigation, and mobile health reminders delivered by bilingual community health educators. Chi-square test and t-test were used to compare demographic characteristics and two CHB measures: CHB clinical follow-up and CHB laboratory monitoring by the time of the 12-month follow-up assessment. A generalized linear mixed-effects model (GLMM) was fitted to assess the effectiveness of the intervention. RESULTS The study sample consisted of 358 Chinese and Vietnamese Americans living with CHB, including 181 in the intervention group and 177 in the control group. The intervention group had a significantly higher rate of CHB clinical follow-up (86.2%) and CHB laboratory monitoring (79.0%) than did the control group (54.2% and 45.2%, respectively). Results of the GLMM showed significant intervention effects on CHB clinical follow-up (odds ratio = 7.35, 95% confidence interval = 4.06-13.33) and CHB laboratory monitoring (odds ratio = 6.60, 95% confidence interval = 3.77-11.56) at the 12-month follow-up assessment. CONCLUSION The multicomponent intervention was effective in improving adherence to CHB monitoring among Asian Americans. Additional implementation research is needed to better understand and apply effective interventions to other underserved populations.
Collapse
Affiliation(s)
- Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Elizabeth Handorf
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY 10065, USA
| | - Cicely Johnson
- Hunter College Center for Cancer Health Disparities Research (CCHDR), Hunter College, City University of New York, New York, NY 10065, USA
| | - Guercie Guerrier
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
| | - Minhhuyen T. Nguyen
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, USA
| |
Collapse
|
|
3
|
Ma GX, Zhu L, Lu W, Tan Y, Truehart J, Johnson C, Handorf E, Nguyen MT, Yeh MC, Wang MQ. Examining the Influencing Factors of Chronic Hepatitis B Monitoring Behaviors among Asian Americans: Application of the Information-Motivation-Behavioral Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4642. [PMID: 35457509 PMCID: PMC9027209 DOI: 10.3390/ijerph19084642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/07/2023]
Abstract
Background: Compared to non-Hispanic whites, Asian Americans are 60% more likely to die from the disease. Doctor visitation for chronic hepatitis B (CHB) infection every six months is an effective approach to preventing liver cancer. Methods: This study utilized baseline data from an ongoing randomized controlled clinical trial aimed at improving long-term adherence to CHB monitoring/treatment. Guided by the information-motivation-behavioral skills (IMB) model, we examined factors associated with CHB monitoring adherence among Asian Americans with CHB. Multivariable logistic regression was conducted to test the associations. Results: The analysis sample consisted of 382 participants. Multivariable logistic regression showed that HBV knowledge (OR = 1.24, p < 0.01) and CHB-management motivation (OR = 1.06, p < 0.05) are significant predictors of having a doctor’s visit in the past six months. Both factors were positively associated with the likelihood of having had blood tests for HBV in the past six months. Conclusion: We found that greater HBV-related knowledge and CHB-management motivation are significantly associated with performing CHB-monitoring behaviors in the past six months. The findings have critical implications for the development and implementation of evidence-based interventions for CHB monitoring and liver cancer prevention in the Asian American community.
Collapse
Affiliation(s)
- Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
- Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, PA 19120, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
| | - Jade Truehart
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (Y.T.); (J.T.)
| | - Cicely Johnson
- Center for Cancer Health Disparities Research (CCHDR), Hunter College, City University of New York, New York, NY 10065, USA;
| | - Elizabeth Handorf
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, USA; (E.H.); (M.T.N.)
| | - Minhhuyen T. Nguyen
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, USA; (E.H.); (M.T.N.)
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY 10065, USA;
| | - Min Qi Wang
- School of Public Health, University of Maryland, College Park, MD 20742, USA;
| |
Collapse
|