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Yendewa GA, Salata RA, Olasehinde T, Mulindwa F, Jacobson JM, Mohareb AM. Self-reported hepatitis B testing among noninstitutionalized adults in the United States before the implementation of universal screening, 2013-2017: A nationwide population-based study. J Viral Hepat 2024. [PMID: 39078109 DOI: 10.1111/jvh.13985] [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: 01/06/2024] [Revised: 06/09/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024]
Abstract
In 2023, the US Centers for Disease Control and Prevention recommended universal screening for hepatitis B virus (HBV); however, the proportion of US adults screened before implementing this recommendation is unknown. We analysed nationally representative data from the National Health Interview Survey (2013-2017) on self-reported HBV testing among noninstitutionalized US adults ≥18 years. We employed Poisson logistic regression to identify factors associated with self-reported testing, using a conceptual framework that included four overarching factors: sociodemographic characteristics, healthcare access, health-seeking behaviours and experiences, and access to internet-based health information. Among 149,628 survey respondents, the self-reported HBV testing rate was 27.2% (95% CI 26.2-28.7) and increased by 1.7% from 2013 to 2017 (p = .006). In adjusted analysis, health-seeking behaviours and experiences had the strongest associations of self-reported testing including a history of hepatitis (AOR 2.68, 95% CI 1.92-3.73), receipt of hepatitis B vaccination (AOR 5.11, 95% CI 4.61-5.68) and prior testing for hepatitis C (AOR 9.14, 95% CI 7.97-10.48) and HIV (AOR 2.69, 95% CI 2.44-2.97). Other factors associated with testing included being male (AOR 1.14, 95% CI 1.03-1.26), ages 30-44 years (AOR 1.37, 95% CI 1.17-1.61), 45-60 years (AOR 1.55, 95% CI 1.30-1.80) and ≥60 years (AOR 1.53, 95% CI 1.28-1.84), residence in the Western US region (AOR 1.23, 95% CI 1.06-1.43), and access to internet-based health information (AOR 1.32, 95% CI 1.18-1.47). Being Hispanic was associated with lower odds of testing (AOR 0.80, 95% CI 0.66-0.97). These findings may help guide optimal HBV screening in the universal testing era.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Temitope Olasehinde
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Frank Mulindwa
- United Health Services Wilson Medical Center, Johnson City, New York, USA
| | - Jeffrey M Jacobson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Amir M Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Silliman M, Alber JM, Gib S, Gee M, Conover S, Chan C, Cohen C, Freeland C, Racho R. Comparing lengths and inclusion of information in storytelling videos: Implications for Hepatitis B education. PEC INNOVATION 2022; 1:100049. [PMID: 37213761 PMCID: PMC10194295 DOI: 10.1016/j.pecinn.2022.100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 05/23/2023]
Abstract
Objectives This study examined whether adding disease-specific facts into storytelling videos and altering video length would lead to differences in overall ratings of the video and the storyteller, as well as hepatitis B prevention beliefs, among Asian American and Pacific Islander adults. Methods A sample of Asian American and Pacific Islander adults (N = 409) completed an online survey. Each participant was randomly assigned to 1 of 4 conditions that varied in video length and use of additional hepatitis B facts. Linear regressions were used to examine differences in outcomes (i.e., video rating, speaker rating, perceived effectiveness, hepatitis B prevention beliefs) by conditions. Results Condition 2, which added facts to the original full-length video, was significantly related to higher speaker ratings (i.e., the storyteller's rating) compared to Condition 1, the original full-length video with no added facts, p = 0.016. Condition 3, which added facts to the shortened video, was significantly related to lower overall video ratings (i.e., how much participants liked the videos overall) compared to Condition 1, p = 0.001. There were no significant differences in higher positive hepatitis B prevention beliefs across conditions. Conclusions Results suggest that adding disease-specific facts to storytelling for patient education may improve initial perceptions of storytelling videos; however, more research is needed to examine long-term effects. Innovation Aspects of storytelling videos such as length and additional information have been rarely explored in storytelling research. This study provides evidence that exploring these aspects is informative to future storytelling campaigns and disease-specific prevention.
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Affiliation(s)
- Miriam Silliman
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Julia M. Alber
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
- Corresponding author at: Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, 1 Grand Avenue, Office 43A-367, San Luis Obispo, CA 93407, USA.
| | - Siena Gib
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Michelle Gee
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Sydney Conover
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Cindi Chan
- California Polytechnic State University, Department of Kinesiology and Public Health, San Luis Obispo, 1 Grand Avenue, San Luis Obispo, CA 93401, USA
| | - Chari Cohen
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA, 18902, USA
| | - Catherine Freeland
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA, 18902, USA
| | - Rhea Racho
- Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA, 18902, USA
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Zhu L, Lu W, Gamoso W, Tan Y, Johnson C, Ma GX. The Association between Modifiable Lifestyle Behaviors and Depression among Asian Americans with Chronic Hepatitis B by Medication Status. Brain Sci 2022; 12:188. [PMID: 35203951 PMCID: PMC8870133 DOI: 10.3390/brainsci12020188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Asian Americans are disproportionately affected by chronic hepatitis B (CHB), with incidence and mortality rates well above those experienced by non-Hispanic white populations. The goal of this study was to examine the association between depression and modifiable lifestyle behaviors among Asian Americans with CHB, with a comparison between those on hepatitis medication and those not on medication. In total, 313 Asian Americans with CHB were recruited through outpatient clinics and community-based organizations to participate in an in-person baseline assessment. We collected data on participants' sociodemographic characteristics, health-related behaviors, depression symptoms, and modifiable lifestyle behaviors. Bivariate analyses (two sample t-test and chi-square test of independence) and multivariable logistic regression were conducted. We found a high prevalence of depression among individuals living with CHB (41.81% among those not on antiviral medication and 39.71% among those on medication). Multivariate logistic regression results showed that Chinese ethnicity (vs. Vietnamese) and lack of physical activity were significantly associated with a higher risk of mild/severe depression, regardless of medication status. However, the protective effect of physical activity was strong for those on antiviral medication. Furthermore, being employed was significantly associated with a lower risk for depression among Asian Americans on medication, while younger age and being currently married were significantly associated with lower risk of depression among those not on medication. Our findings highlight the significance of physical activity among Asian Americans with CHB, especially for those on antiviral medication. Future prospective research efforts are needed to better identify the potential behavioral mechanisms of depression and provide insights for the psychopharmacological management in this vulnerable population.
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Affiliation(s)
- Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (W.G.); (Y.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.); (W.G.); (Y.T.)
| | - Winterlyn Gamoso
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (W.G.); (Y.T.)
- School of Urban Public Health, Hunter College, City University of New York, New York, NY 10065, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (W.G.); (Y.T.)
| | - Cicely Johnson
- Hunter College Center for Cancer Health Disparities Research (CCHDR), Hunter College, City University of New York, New York, NY 10065, USA;
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (L.Z.); (W.L.); (W.G.); (Y.T.)
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
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Le D, Hong A, Hui SKA, Rimal RN, Juon HS. Assessment of Hepatitis B Virus Screening Behaviors among Asian-Americans through the Lens of Social Cognitive Theory. CALIFORNIAN JOURNAL OF HEALTH PROMOTION 2021; 19:76-83. [PMID: 34566536 DOI: 10.32398/cjhp.v19i1.2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Purpose Asian-Americans suffer from significant liver cancer disparity caused by chronic hepatitis B virus (HBV) infection. Understanding psychosocial predictors of HBV screening is critical to designing effective interventions. Methods Chinese-, Korean-, and Vietnamese-Americans in the Baltimore-Washington metropolitan region (N=877) were recruited from community-based organizations. Applying the Social Cognitive Theory (SCT), three main theoretical constructs (knowledge, outcome expectancy, and self-efficacy) were tested. Descriptive analyses using Chi-square and ANOVA and multivariate logistic regression models were conducted. Results About 47% of participants reported ever having screening for HBV. Vietnamese-Americans had the lowest HBV screening rate (39%), followed by Korean-Americans (46%) and Chinese-Americans (55%). Multiple logistic regression analyses showed significant effects of HBV-related knowledge on screening in all three groups, whereas self-efficacy had significant effects in the Chinese and Korean subgroups, but not Vietnamese. HBV outcome expectancy had no effect on the screening outcome in any of the groups. Additionally, consistent in all three groups, those who had lived in the United States longer were less likely to have screening. Conclusion HBV screening rates in Asian Americans remain low; targeted interventions need to consider the differences across ethnic subgroups and address the psychosocial risk factors.
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Ma GX, Zhu L, Tan Y, Zhai S, Lin TR, Zambrano C, Siu P, Lai S, Wang MQ. A Multilevel Intervention to Increase HPV Vaccination among Asian American Adolescents. J Community Health 2021; 47:9-16. [PMID: 34232452 PMCID: PMC8738771 DOI: 10.1007/s10900-021-01013-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/05/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the US. HPV vaccine is a viable source of prevention against high-risk strains that are likely to cause cancer. However, particularly among racial and ethnic minorities such as Chinese Americans, HPV vaccination rates are suboptimal. The goal of this study was to evaluate the effect of a culturally tailored intervention on HPV vaccine uptake in Chinese Americans. We designed and implemented a multilevel longitudinal pilot study to examine the efficacy of the HPV intervention among Chinese American parents/guardians. We recruited 180 participants from federally qualified health center and community-based clinics that serve predominantly low-income Chinese Americans in Philadelphia. Participants were randomized into an intervention group (n = 110) or a control group (n = 70). The intervention group received an HPV specific intervention, while the control group received a general health intervention. The primary outcome was medical record-confirmed receipt of first shot and completion of HPV vaccine within six months of receiving the interventions. Repeated measure ANOVA was utilized to examine the intervention effect on knowledge between intervention and control groups. Knowledge differed significantly, with participants in the intervention group demonstrating the greatest improvement following the intervention. A multivariable logistic regression was used to examine the association between HPV vaccine initiation and study group assignment. There was a significant effect of provider recommendation, parent’s gender, and health insurance status on HPV vaccine uptake. This study demonstrated positive impact of a culturally tailored intervention on HPV vaccination uptake among Chinese Americans.
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Affiliation(s)
- Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.
- Fox Chase Cancer Center, Temple University Health System, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Shumenghui Zhai
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Timmy R Lin
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Cristina Zambrano
- Hunter College Center for Cancer Health Disparities Research, 695 Park Avenue, New York, NY, 10065, USA
| | - Philip Siu
- Greater Philadelphia Health Action, Inc., 432 N 6th St, Philadelphia, PA, 19123, USA
| | - Sarah Lai
- Greater Philadelphia Health Action, Inc., 432 N 6th St, Philadelphia, PA, 19123, USA
| | - Min Qi Wang
- School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD, 20742, USA
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Alber JM, Cohen C, Racho R, Freeland C, Ghazvini S, Tolentino B, Almeida R, Silliman M. Exploring the Impact of Storytelling on Storytellers in a Hepatitis B Health Communication Context. PATIENT EDUCATION AND COUNSELING 2020; 103:1760-1766. [PMID: 32331825 DOI: 10.1016/j.pec.2020.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/21/2020] [Accepted: 03/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In order to address the stigma associated with hepatitis B, increase awareness, encourage testing, and promote prevention through vaccination, a storytelling campaign featuring people living with hepatitis B and their family members was developed. Storytelling campaigns have been evaluated for their impact on the viewing audience; however, few studies have examined the impact of storytelling on storytellers themselves. This study seeks to examine the experiences of the individuals telling their stories. METHODS Trained researchers conducted semi-structured interviews (n = 23) with individuals who had participated in a hepatitis B storytelling campaign. RESULTS A thematic analysis of the interviews produced four overarching themes: 1) Outreach; 2) Emotion; 3) Education; and 4) Stigma. The interviews demonstrate that participants found storytelling to be a positive, comfortable, and emotional experience, and that it motivated them to educate others and increase awareness. Additionally, participants identified the need to increase outreach and address stigma related to hepatitis B. CONCLUSION While more research is needed, these study results can be used to enhance future engagement, training, and experiences of hepatitis B storytellers. PRACTICE IMPLICATIONS Findings provide insight into how storytelling can impact the sharing their story and provide important implications for future storytelling campaigns.
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Affiliation(s)
- Julia M Alber
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, USA.
| | | | - Rhea Racho
- Hepatitis B Foundation, Doylestown, USA.
| | | | - Sanam Ghazvini
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, USA.
| | - Brenda Tolentino
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, USA.
| | - Rebeca Almeida
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, USA.
| | - Miriam Silliman
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, USA.
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Kye SY, Han KT, Choi J, Jho HJ, Park SJ, Song IG, Nam EJ, Chang YJ. Associations Between the Intention to Use Early Palliative Care, Sources of Information, and Attitudes Toward a Good Death in Korean Adults. J Pain Symptom Manage 2020; 60:503-511. [PMID: 32335202 DOI: 10.1016/j.jpainsymman.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Providing hospice and palliative care (HPC) early in the course of care for patients with life-threatening illness is important for improving patient quality of life. However, little literature exists for factors affecting to the intention to use early palliative care (EPC) of general population. OBJECTIVES This study aimed to identify the sources of information about HPC, investigate whether they affect intention to use HPC and EPC, and examine the relationship between the components of a good death and the intention to use HPC and EPC. METHODS A stratified nationwide cross-sectional survey including 1500 participants, 20-74 years old, was conducted to investigate their intentions to use HPC and EPC, available information sources, and perceived components of a good death. RESULTS The main sources of information about HPC were television and radio. Information acquired from health professionals was positively associated with the intention to use EPC. Although regarding a good relationship with family as a component of a good death was related to low intention to use EPC, being able to trust medical staff, being involved in decisions about care, and being respected as an individual were associated with high intention to use EPC. CONCLUSION Information from health care providers and public awareness through education and publicity efforts are necessary to inform the public about the benefits of EPC. Furthermore, it is essential that medical staff cultivate the skills necessary to secure public trust and provide care that respects patients until the end of their lives.
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Affiliation(s)
- Su Yeon Kye
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyu-Tae Han
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jinyoung Choi
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyun Jung Jho
- Department of Hospice Palliative Service, National Cancer Center, Goyang, Korea
| | - So Jung Park
- National Hospice Center, National Cancer Center, Goyang, Korea
| | - In Gyu Song
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Jung Nam
- National Hospice Center, National Cancer Center, Goyang, Korea
| | - Yoon Jung Chang
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
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The Lived Experience of Chronic Hepatitis B: A Broader View of Its Impacts and Why We Need a Cure. Viruses 2020; 12:v12050515. [PMID: 32392763 PMCID: PMC7290920 DOI: 10.3390/v12050515] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic hepatitis B (CHB) is one of the most widespread liver diseases in the world. It is currently incurable and can lead to liver cirrhosis and cancer. The considerable impacts on society caused by CHB through patient mortality, morbidity, and economic loss are well-recognised in the field. This is, however, a narrow view of the harms, given that people living with CHB can be asymptomatic for the majority of their life-long infection. Of less-appreciated importance are the psychosocial harms, which can continue throughout an affected person's lifetime. Here we review the broad range of these impacts, which include fear and anxiety; financial loss and instability; stigma and discrimination; and rejection by society. Importantly, these directly affect patient diagnosis, management, and treatment. Further, we highlight the roles that the research community can play in taking these factors into account and mitigating them. In particular, the development of a cure for hepatitis B virus infection would alleviate many of the psychosocial impacts of CHB. We conclude that there should be a greater recognition of the full impacts associated with CHB to bring meaningful, effective, and deliverable results to the global community living with hepatitis B.
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Cudjoe J, Delva S, Cajita M, Han HR. Empirically Tested Health Literacy Frameworks. Health Lit Res Pract 2020; 4:e22-e44. [PMID: 32053206 PMCID: PMC7015262 DOI: 10.3928/24748307-20191025-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Health literacy is a significant determinant of health behaviors, but the pathways through which health literacy influences health behaviors are not completely clear nor consistent. The purpose of this systematic review is to critically appraise studies that have empirically tested the potential pathways linking health literacy to health behavior. Methods: We performed searches of the electronic databases PubMed, Embase, and CINAHL to identify studies that proposed a conceptual framework and empirically tested the proposed mechanism through which health literacy influences certain health behaviors. Twenty eligible studies were included for analysis. Key Results: The 20 studies addressed various health behaviors: chronic disease self-management (n = 8), medication adherence (n = 2), overall health status (n = 4), oral care (n = 1), cancer screening (n = 1), shared decision-making (n = 1), health information sharing (n = 1), physical activity and eating behaviors (n = 1), and emergency department visits (n = 1). Most studies were conducted in the United States (n = 13) and used a cross-sectional design (n = 15). The Short Test of Functional Health Literacy in Adults was commonly used to assess health literacy levels. Selection of variables and their operationalization were informed by a theoretical model in 12 studies. Age, gender, race/ethnicity, and insurance status were reported antecedents to health literacy. The most commonly tested mediators were self-efficacy (n = 8) and disease knowledge (n = 4). Fit indices reported in the studies ranged from acceptable to excellent. Discussion: Current evidence supports self-efficacy as a mediator between health literacy and health behavior. Further research is needed to identify how health literacy interplays with known psychosocial factors to inform people's use of preventive care services. Future studies should include more disadvantaged populations such as immigrants with high disease burden and those with low health literacy. Theory-based, empirically tested health literacy models can serve as the conceptual basis for developing effective health interventions to improve health behaviors and ultimately decrease the burden of disease in such vulnerable populations. [HLRP: Health Literacy Research and Practice. 2020;4(1):e21–e44.] Plain Language Summary: This review systemically compiles, and critically appraises 20 existing studies that test conceptual frameworks that propose potential pathways through which health literacy affects health behaviors. The findings from this review can help inform the development of health literacy-focused interventions to improve the health behaviors of populations with disease burdens.
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Affiliation(s)
- Joycelyn Cudjoe
- Address correspondence to Joycelyn Cudjoe, PhD, RN, Inova Health System, 8110 Gatehouse Road, Suite 200W, Falls Church, VA 22042;
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Alber JM, Cohen C, Bleakley A, Ghazvini SF, Tolentino BT, Almeida R, Chance BL. Comparing the Effects of Different Story Types and Speakers in Hepatitis B Storytelling Videos. Health Promot Pract 2020; 21:811-821. [PMID: 31955614 DOI: 10.1177/1524839919894248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic hepatitis B, a condition associated with severe complications, disproportionately affects Asian Americans and Pacific Islanders in the United States. Increasing testing among this population is critical for improving health outcomes. This study compares different types of video narratives that use storytelling techniques to an informational video (control), to examine whether narratives are associated with higher hepatitis B beliefs scores and video rating outcomes. A sample of Asian American and Pacific Islander adults (N = 600) completed an online survey where they viewed one of four video conditions, three of which included storytelling techniques and one with informational content. Results indicated that parental stories received significantly higher perceived effectiveness ratings (M = 3.88, SD = 0.61) than the older adult personal stories (M = 3.62, SD = 0.74), F(3, 596) = 3.795, p = .010. Parental stories also had significantly higher perceived severity scores (M = 3.83, SD = 0.69) compared to the young adult stories (M = 3.73, SD = 0.74) and the informational videos (M = 3.83, SD = 0.69), F(3, 596) = 7.72, p < .001. The informational videos (M = 4.10, SD = 0.65) received significantly higher message credibility ratings than the older adult personal stories (M = 3.84, SD = 0.70), F(3, 596) = 4.71, p = .003. Follow-up tests using Bonferroni correction revealed that parental stories (M = 3.98, SD = 0.64) and young adult personal stories (M = 3.934, SD = 0.76) scored significantly higher on speaker ratings than the older adult personal stories (M = 3.698, SD = 0.77). Results suggest that storytelling has the potential for connecting with a specific audience in an emotional way that is perceived well overall. Future research should examine the long-term impact of hepatitis B personal story videos and whether the addition of facts or statistics to videos would improve outcomes.
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Affiliation(s)
- Julia M Alber
- California Polytechnic State University, San Luis Obispo, CA, USA
| | | | - Amy Bleakley
- University of Pennsylvania, Philadelphia, PA, USA
| | - Sanam F Ghazvini
- California Polytechnic State University, San Luis Obispo, CA, USA
| | | | - Rebeca Almeida
- California Polytechnic State University, San Luis Obispo, CA, USA
| | - Beth L Chance
- California Polytechnic State University, San Luis Obispo, CA, USA
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Alber JM, Cohen C, Nguyen GT, Ghazvini SF, Tolentino BT. Exploring Communication Strategies for Promoting Hepatitis B Prevention among Young Asian American Adults. JOURNAL OF HEALTH COMMUNICATION 2018; 23:977-983. [PMID: 30325705 DOI: 10.1080/10810730.2018.1534904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the United States, Asian Americans account for 50-60% of hepatitis B virus infections, leading to higher rates of liver cancer in this population. While some city-wide data have reported hepatitis B infection rates among young adults as high as 10-20%, little research has examined factors that impact hepatitis B beliefs, or the most effective strategies for reaching this particular population to promote hepatitis B awareness. An online survey was conducted with young Asian American adults (n = 418), aged 18-29 years old, to better understand their health information seeking, social media usage, and hepatitis B-related behaviors and beliefs. Results indicated that doctors and health organizations were the most trusted sources of health information, while the Internet was the most common source of health information. The majority of participants (99.8%) reported using social media and indicated they engaged in health-related behaviors on social media. Several factors, including non-receipt of hepatitis B vaccine, engaging in more health-related social media activities, and a higher mean score for difficulty with health information seeking, were significantly related to higher perceived susceptibility to hepatitis B. Future research should explore the effectiveness of using social media to reach young Asian American adults to promote hepatitis B awareness.
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Affiliation(s)
- Julia M Alber
- a Department of Kinesiology and Public Health , California Polytechnic State University , San Luis Obispo , California , USA
| | - Chari Cohen
- b Hepatitis B Foundation , Doylestown , Pennsylvania , USA
| | - Giang T Nguyen
- c Student Health Service , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Sanam F Ghazvini
- a Department of Kinesiology and Public Health , California Polytechnic State University , San Luis Obispo , California , USA
| | - Brenda Trang Tolentino
- a Department of Kinesiology and Public Health , California Polytechnic State University , San Luis Obispo , California , USA
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12
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Juon HS, Rimal RN, Klassen A, Lee S. Social Norm, Family Communication, and HBV Screening among Asian Americans. JOURNAL OF HEALTH COMMUNICATION 2017; 22:981-989. [PMID: 29173103 PMCID: PMC5809127 DOI: 10.1080/10810730.2017.1388454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Individuals' behaviors are influenced by those of others in their social environment (i.e., descriptive norms), as well as by how individuals perceive they should behave in that environment (e.g., injunctive norms). Although social norms are thought to play an important role in hepatitis B virus (HBV) screening, limited theoretical or empirical guidance exists on how the underlying process works. In addition, norms are social phenomena that are spread through family discussion about the importance of getting HBV screening. Using the theory of normative social behavior (TNSB), this study examined the roles of injunctive norms (IN), descriptive norms (DN), and family discussion in HBV screening behavior among Asian Americans. Data from a survey of Asian Americans in the Baltimore Washington metropolitan area (N = 877) were used to test underlying theoretical propositions. DN and family discussion emerged as key factors in HBV screening behavior among all Asian Americans. IN were associated with HBV screening among Chinese and Korean Americans, but not for Vietnamese Americans. Family discussion moderated the influence of DN on behavior among Chinese and Vietnamese Americans. However, the main effect of DN on screening behavior was not modified by IN (no interactions between DN and IN). The results indicate that family discussion and social norms are integral in enabling Asian Americans to undergo HBV screening and warrant sensitivity in the design and implementation of a liver cancer prevention program in this high-risk group of Asian Americans.
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Affiliation(s)
- Hee-Soon Juon
- a Department of Medical Oncology , Thomas Jefferson University , Philadelphia , Pennsylvania , USA
| | - Rajiv N Rimal
- b Department of Prevention and Community Health , George Washington University , Washington , DC , USA
| | - Ann Klassen
- c Department of Community Health and Prevention , Drexel University Dornsife School of Public Health , Philadelphia , Pennsylvania , USA
| | - Sunmin Lee
- d Department of Epidemiology and Biostatistics , University of Maryland School of Public Health , College Park , Maryland , USA
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Lee ACK, Vedio A, Liu EZH, Horsley J, Jesurasa A, Salway S. Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study. BMC Public Health 2017; 17:747. [PMID: 28950835 PMCID: PMC5615445 DOI: 10.1186/s12889-017-4796-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 09/21/2017] [Indexed: 12/28/2022] Open
Abstract
Background Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England. Methods We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as ‘Chinese’, and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops. Results Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, ‘cultural competency’ training, and locally adapted testing protocols may help. Conclusions Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle barriers within this population and the health system. Electronic supplementary material The online version of this article (10.1186/s12889-017-4796-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrew Chee Keng Lee
- Section of Public Health, the School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK.
| | - Alicia Vedio
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Eva Zhi Hong Liu
- Section of Public Health, the School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK
| | - Jason Horsley
- Public Health Department, Sheffield City Council, Sheffield, UK
| | - Amrita Jesurasa
- Section of Public Health, the School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK
| | - Sarah Salway
- Section of Public Health, the School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK
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14
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Vedio A, Liu EZH, Lee ACK, Salway S. Improving access to health care for chronic hepatitis B among migrant Chinese populations: A systematic mixed methods review of barriers and enablers. J Viral Hepat 2017; 24:526-540. [PMID: 28092419 PMCID: PMC5516707 DOI: 10.1111/jvh.12673] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/22/2016] [Indexed: 12/26/2022]
Abstract
Migrant Chinese populations in Western countries have a high prevalence of chronic hepatitis B but often experience poor access to health care and late diagnosis. This systematic review aimed to identify obstacles and supports to timely and appropriate health service use among these populations. Systematic searches resulted in 48 relevant studies published between 1996 and 2015. Data extraction and synthesis were informed by models of healthcare access that highlight the interplay of patient, provider and health system factors. There was strong consistent evidence of low levels of knowledge among patients and community members; but interventions that were primarily focused on increasing knowledge had only modest positive effects on testing and/or vaccination. There was strong consistent evidence that Chinese migrants tend to misunderstand the need for health care for hepatitis B and have low satisfaction with services. Stigma was consistently associated with hepatitis B, and there was weak but consistent evidence of stigma acting as a barrier to care. However, available evidence on the effects of providing culturally appropriate services for hepatitis B on increasing uptake is limited. There was strong consistent evidence that health professionals miss opportunities for testing and vaccination. Practitioner education interventions may be important, but evidence of effectiveness is limited. A simple prompt in patient records for primary care physicians improved the uptake of testing, and a dedicated service increased targeted vaccination coverage for newborns. Further development and more rigorous evaluation of more holistic approaches that address patient, provider and system obstacles are needed.
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Affiliation(s)
- A. Vedio
- Department of Infection and Tropical MedicineSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
- Public HealthSchool of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - E. Z. H. Liu
- Public HealthSchool of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - A. C. K. Lee
- Public HealthSchool of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - S. Salway
- Public HealthSchool of Health and Related ResearchUniversity of SheffieldSheffieldUK
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Li S, Sim SC, Lee L, Pollack HJ, Wyatt LC, Trinh-Shevrin C, Pong P, Kwon SC. Hepatitis B Screening & Vaccination Behaviors in a Community-based Sample of Chinese & Korean Americans in New York City. Am J Health Behav 2017; 41:204-214. [PMID: 28452698 PMCID: PMC5472990 DOI: 10.5993/ajhb.41.2.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES As Asian Americans are dis- proportionately affected by the hepatitis B virus (HBV), we explored predictors of HBV screening and vaccination among Chinese and Korean Americans. METHODS We used cross-sectional data from a com- munity-based sample of Chinese Americans (N = 502) and Korean Americans (N = 487) residing in the metropolitan New York City area during 2008-2009. Logistic regression models were stratified by Asian-American subgroup and sex to predict HBV screening (for the entire sam- ple) and HBV vaccination (among those not HBV positive). RESULTS Overall, screening rates were high (71.3% among Chinese and 70.1% among Koreans). The majority of respondents were aware of HBV; however, knowledge about HBV transmission was low. In logistic regression, a physician recommendation was consistently associated with HBV screening and vaccination outcomes across all groups; having heard of HBV was significantly associated with screening and vaccination among Chinese males and screening among Korean males and females. Screening and vaccination barriers were reported among all groups, and included lack of knowledge and feeling well/having no health issues. CONCLUSIONS Targeted efforts in these at-risk communities are necessary to improve HBV knowledge, address misinformation about HBV, and eliminate provider-, patient-, and resource-related barriers to HBV screening and vaccination.
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Affiliation(s)
- Shijian Li
- SUNY Old Westbury, Department of Public Health, Old Westbury, NY, USA
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Gesser-Edelsburg A, Shalayeva S. Internet as a Source of Long-Term and Real-Time Professional, Psychological, and Nutritional Treatment: A Qualitative Case Study Among Former Israeli Soviet Union Immigrants. J Med Internet Res 2017; 19:e33. [PMID: 28159729 PMCID: PMC5315766 DOI: 10.2196/jmir.7130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/22/2017] [Accepted: 01/22/2017] [Indexed: 11/17/2022] Open
Abstract
Background The Internet is considered to be an effective source of health information and consultation for immigrants. Nutritional interventions for immigrants have become increasingly common over the past few decades. However, each population of immigrants has specific needs. Understanding the factors influencing the success of nutrition programs among immigrants requires an examination of their attitudes and perceptions, as well as their cultural values. Objective The purpose of this study was to examine perceptions of the Internet as a tool for long-term and “real-time” professional, psychological, and nutritional treatment for immigrants from the former Soviet Union who immigrated to Israel (IIFSU) from 1990 to 2012. Methods A sample of nutrition forum users (n=18) was interviewed and comments of 80 users were analyzed qualitatively in accordance with the grounded theory principles. Results The results show that IIFSU perceive the Internet as a platform for long-term and “real-time” dietary treatment and not just as an informative tool. IIFSU report benefits of online psychological support with professional dietary treatment. They attribute importance to cultural customization, which helps reduce barriers to intervention. Conclusions In light of the results, when formulating nutritional programs, it is essential to have a specific understanding of immigrants’ cultural characteristics and their patterns of Internet use concerning dietary care.
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Affiliation(s)
- Anat Gesser-Edelsburg
- University of Haifa Health and Risk Communication Research Center, School of Public Health, University of Haifa, Haifa, Israel
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