Medical Care of Hepatitis B among Asian American Populations: Perspectives from Three Provider Groups
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Physicians can play a significant role in helping to decrease the hepatitis B virus (HBV) burden among Asian Americans. Few studies have described knowledge and practice patterns in the medical community among different provider types regarding HBV and liver cancer.
Our study explores the HBV beliefs, attitudes and practice patterns of medical providers serving Asian American communities.
We conducted three focus groups with primary care providers, liver specialists, and other providers predominantly serving Asian American community. We asked about practices and barriers to appropriate medical care and outreach.
We moderated three focus groups with 23 participants, 18 of whom completed and returned demographic surveys. Twelve were of Asian ethnicity and 13 spoke English as a second language. Only eight screened at least half of their patients, most (72%) using the hepatitis B surface antigen test.
We used grounded theory methods to analyze focus group transcripts.
Participants frequently discussed cultural and financial barriers to hepatitis care. They admitted reluctance to screen for HBV because patients might be unwilling or unable to afford treatment. Cultural differences were discussed most by primary care providers; best methods of outreach were discussed most by liver specialists; and alternative medicine was discussed most by acupuncturists and other providers.
More resources are needed to lower financial barriers complicating HBV care and encourage providing guideline-recommended screenings. Other providers can help promote HBV screening and increase community and cultural awareness.
- U.S. Department of Health and Human Services. Public Health Service. National Toxicology Program. Report on Carcinogens, Eleventh Edition. 2005.
- Centers for Disease Control and Prevention. Asian American Populations. Available at: http://www.cdc.gov/omhd/populations/AsianAm/AsianAm.htm. Accessed on November 13, 2009.
- Chao SD, Chang ET, So SK. Eliminating the threat of chronic hepatitis B in the Asian and Pacific Islander community: a call to action. Asian Pac J Cancer Prev. 2009;10(3):507–12.
- Hwang J, Hassan MM. Survival and hepatitis status among Asian Americans with hepatocellular carcinoma treated without liver transplantation. BMC Cancer. 2009;9:46. CrossRef
- U.S. Department of Health and Human Services. Office of Minority Health. Chronic Hepatitis B in Asian Americans, Native Hawaiians and other Pacific Ilanders. Available at: http://www.omhrc.gov/templates/content.aspx?ID=7240. Accessed on November 13, 2009.
- Sorrell MF, Belongia EA, Costa J, et al. National institutes of health consensus development conference statement: management of hepatitis B. Ann Intern Med. 2009;150(2):104–10.
- Taylor VM, Jackson JC, Pineda M, Pham P, Fischer M, Yasui Y. Hepatitis B knowledge among Vietnamese immigrants: implications for prevention of hepatocellular carcinoma. J Cancer Educ. 2000;15(1):51–5.
- Taylor VM, Jackson JC, Chan N, et al. Hepatitis B knowledge and practices among Cambodian American women in Seattle, Washington. J Community Health. 2002;27(3):151–63. CrossRef
- Thompson MJ, Taylor VM, Jackson JC, et al. Hepatitis B knowledge and practices among Chinese American women in Seattle, Washington. J Cancer Educ. 2002;17(4):222–6.
- Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat. 2004;11(2):97–107. CrossRef
- Tsai N. Management of chronic hepatitis B in Asian Americans and pacific islanders. Gastroenterol Hepatol. 2005;1(3):188–94.
- Friedman DS, Hahn SR, Gelb L, et al. Doctor-patient communication, health-related beliefs, and adherence in glaucoma results from the Glaucoma Adherence and Persistency Study. Ophthalmology. 2008;115(8):1320–7. CrossRef
- Bourbeau J, Bartlett SJ. Patient adherence in COPD. Thorax. 2008;63(9):831–8. CrossRef
- Jayasinghe J. Non-adherence in the hypertensive patient: can nursing play a role in assessing and improving compliance? Can J Cardiovasc Nurs. 2009;19(1):7–12.
- Spink KS, Reeder B, Chad K, Wilson K, Nickel D. Examining physician counselling to promote the adoption of physical activity. Can J Public Health. 2008;99(1):26–30.
- Lee YY, Lin JL. The effects of trust in physician on self-efficacy, adherence and diabetes outcomes. Soc Sci Med. 2009;68(6):1060–8. CrossRef
- Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40(7):903–18. CrossRef
- Kerse N, Buetow S, Mainous AG 3rd, et al. Physician-patient relationship and medication compliance: a primary care investigation. Ann Fam Med. 2004;2(5):455–61. CrossRef
- Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3 Suppl):S110–27. Erratum in: Med Care. 1989;27(7):679. CrossRef
- Wee CC, McCarthy EP, Phillips RS, Wee CC, McCarthy EP, Phillips RS. Factors associated with colon cancer screening: the role of patient factors and physician counseling. Prev Med. 2005;41(1):23–9. CrossRef
- Simpson M, Buckman R, Stewart M, et al. Doctor-patient communication: the Toronto consensus statement. BMJ. 1991;303(6814):1385–7. CrossRef
- Lai CJ, Nguyen TT, Hwang J, et al. Provider knowledge and practice regarding hepatitis B screening in Chinese-speaking patients. J Cancer Educ. 2007;22(1):37–41. CrossRef
- Morgan DM, ed. Successful Focus Groups: Advancing the state of the art. Vol 156. Newbury Park, CA: SAGE Publications: 1993.
- Krueger R. Focus Groups: a practical guide for applied research. Thousand Oaks: Sage Publications; 1994.
- Burke NJ, Jackson JC, Thai HC, et al. Honoring tradition, accepting new ways: development of a hepatitis B control intervention for Vietnamese immigrants. Ethn Health. 2004;9(2):153–69. CrossRef
- Choe JH, Chan N, Do HH, Woodall E, Lim E, Taylor VM. Hepatitis B and liver cancer beliefs among Korean immigrants in Western Washington. Cancer. 2005;104(12 Suppl):2955–8. CrossRef
- Strauss AC, Corbin J, eds. Grounded theory in practice. Thousand Oaks: Sage Publications; 1997.
- Corbin J, Strauss AC. Basics of qualitative research: techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications; 1998.
- U.S. Census Bureau. American FactFinder. 2006-2008 American Community Survey 3-Year Estimates. Available at: http://factfinder.census.gov. Accessed on November 9, 2009.
- Lok A, McMahon B. AASLD practice guidelines: chronic hepatitis B. Hepatology. 2007;45(2):507–39. CrossRef
- Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep. 2006;55(RR-16):1–33. quiz CE31-34. Erratum in: MMWR Morb Mortal Wkly Rep. 2007;56(42):1114.
- Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology. 2001;34(6):1225–41. CrossRef
- Hampton T. Officials recommend expanded testing for chronic hepatitis B virus infection. JAMA. 2008;300(18):2108. CrossRef
- Lin SY, Chang ET, So SK. Why we should routinely screen Asian American adults for hepatitis B: a cross-sectional study of Asians in California. Hepatology. 2007;46(4):1034–40. CrossRef
- Weinbaum CM, Williams I, Mast EE, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008;57(RR-8):1–20.
- Gaglio PJ, Sterling R, Daniels E, et al. Hepatitis B virus and HIV coinfection: results of a survey on treatment practices and recommendations for therapy.[see comment]. Clin Infect Dis. 2007;45(5):618–23. CrossRef
- Freed GL, Bordley WC, Clark SJ, Konrad TR. Universal hepatitis B immunization of infants: reactions of pediatricians and family physicians over time. Pediatrics. 1994;93(5):747–51.
- Freed GL, Bordley WC, Clark SJ, Konrad TR. Reactions of pediatricians to a new Centers for Disease Control recommendation for universal immunization of infants with hepatitis B vaccine.[see comment]. Pediatrics. 1993;91(4):699–702.
- Winnock M, Neau D, Castera L, et al. Hepatitis B vaccination in HIV-infected patients: a survey of physicians and patients participating in the Aquitaine cohort.[see comment]. Gastroenterol Clin Biol. 2006;30(2):189–95. CrossRef
- Zickmund SL, Brown KE, Bielefeldt K, Zickmund SL, Brown KE, Bielefeldt K. A systematic review of provider knowledge of hepatitis C: is it enough for a complex disease? Dig Dis Sci. 2007;52(10):2550–6. CrossRef
- Hwang JP, Huang CH, Yi JK. Knowledge about hepatitis B and predictors of hepatitis B vaccination among Vietnamese American college students. J Am Coll Health. 2008;56(4):377–82. CrossRef
- Ma GX, Shive SE, Fang CY, et al. Knowledge, attitudes, and behaviors of hepatitis B screening and vaccination and liver cancer risks among Vietnamese Americans. J Health Care Poor Underserved. 2007;18(1):62–73. CrossRef
- Ma GX, Shive SE, Toubbeh JI, Tan Y, Wu D. Knowledge, attitudes, and behaviors of Chinese hepatitis B screening and vaccination. Am J Health Behav. 2008;32(2):178–87.
- Nguyen TT, Taylor V, Chen MS Jr, Bastani R, Maxwell AE, McPhee SJ. Hepatitis B awareness, knowledge, and screening among Asian Americans. J Cancer Educ. 2007;22(4):266–72. CrossRef
- Barrett B, Shadick K, Schilling R, et al. Hmong/medicine interactions: improving cross-cultural health care. Fam Med. 1998;30(3):179–84.
- Ramsay DB, Friedman M, Borum ML, Ramsay DB, Friedman M, Borum ML. Does the race or gender of hepatitis C infected patients influence physicians' assessment of hepatitis A and hepatitis B serologic status? South Med J. 2007;100(7):683–5.
- Flaskerud JH, Liu PY. Effects of an Asian client-therapist language, ethnicity and gender match on utilization and outcome of therapy. Community Ment Health J. 1991;27(1):31–42. CrossRef
- LaVeist TA, Nuru-Jeter A, Jones KE. The association of doctor-patient race concordance with health services utilization.[see comment]. J Public Health Policy. 2003;24(3–4):312–23. CrossRef
- Beach MC, Roter DL, Wang NY, Duggan PS, Cooper LA. Are physicians' attitudes of respect accurately perceived by patients and associated with more positive communication behaviors? Patient Educ Couns. 2006;62(3):347–54. CrossRef
- Meghani SH, Brooks JM, Gipson-Jones T, Waite R, Whitfield-Harris L, Deatrick JA. Patient-provider race-concordance: does it matter in improving minority patients' health outcomes? Ethn Health. 2009;14(1):107–30. CrossRef
- Wahner-Roedler DL, Vincent A, Elkin PL, Loehrer LL, Cha SS, Bauer BA. Physicians' attitudes toward complementary and alternative medicine and their knowledge of specific therapies: a survey at an academic medical center. Evid Based Complement Alternat Med. 2006;3(4):495–501. CrossRef
- Furlow ML, Patel DA, Sen A, Liu JR. Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology. BMC Complement Altern Med. 2008;8:35. CrossRef
- Lee RT, Hlubocky FJ, Hu J-J, Stafford RS, Daugherty CK. An international pilot study of oncology physicians' opinions and practices on Complementary and Alternative Medicine (CAM). Integrative Cancer Therapies. 2008;7(2):70–5. CrossRef
- Kurtz ME, Nolan RB, Rittinger WJ. Primary care physicians' attitudes and practices regarding complementary and alternative medicine. J Am Osteopath Assoc. 2003;103(12):597–602.
- Bourgeault IL. Physicians' attitudes toward patients' use of alternative cancer therapies. CMAJ Can Med Assoc J. 1996;155(12):1679–85.
- Chang ET, Lin SY, Sue E, Bergin M, Su J, So SKS. Building partnerships with traditional chinese medicine practitioners to increase hepatitis B awareness and prevention. J Altern Complement Med. 2007;13(10):1125–7. CrossRef
- Ben-Arye E, Scharf M, Frenkel M. How should complementary practitioners and physicians communicate? A cross-sectional study from Israel. J Am Board Fam Med: JABFM. 2007;20(6):565–71. CrossRef
- Greenfield SM, Brown R, Dawlatly SL, Reynolds JA, Roberts S, Dawlatly RJ. Gender differences among medical students in attitudes to learning about complementary and alternative medicine. Complement Ther Med. 2006;14(3):207–12. CrossRef
- Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142(4):260–73.
- Roter DL, Hall JA. Physician gender and patient-centered communication: a critical review of empirical research. Annu Rev Public Health. 2004;25:497–519. CrossRef
- Todres M, Stephenson A, Jones R. Medical education research remains the poor relation. BMJ. 2007;335(7615):333–5. CrossRef
- Asch DA, Epstein A, Nicholson S. Evaluating medical training programs by the quality of care delivered by their alumni. JAMA. 2007;298(9):1049–51. CrossRef
- Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008;100(11):1275–85.
- Medical Care of Hepatitis B among Asian American Populations: Perspectives from Three Provider Groups
Journal of General Internal Medicine
Volume 25, Issue 3 , pp 220-227
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- provider attitudes
- Hepatitis B
- Asian Americans
- qualitative research
- focus groups
- Industry Sectors
- Author Affiliations
- 1. Department General Internal Medicine, Ambulatory Treatment & Emergency Care, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 1465, Houston, TX, 77030, USA
- 2. University of Houston-Downtown, Houston, TX, USA
- 3. The University of Texas School of Nursing, Houston, TX, USA