Journal of Community Health

, Volume 38, Issue 3, pp 471–479

Community Health Education at Student-Run Clinics Leads to Sustained Improvement in Patients’ Hepatitis B Knowledge

  • David Ouyang
  • Neal Yuan
  • Leslie Sheu
  • Gary Lau
  • Cheng Chen
  • Cindy J. Lai
Original Paper


While student-run clinics are often important healthcare safety nets for underserved populations, their efficacy for improving patient health knowledge has not been thoroughly explored. From September 2011 to April 2012, we assessed patients’ retention of hepatitis B virus (HBV) knowledge after receiving student-led education at two student-run HBV screening and vaccination clinics. Patient education was provided by trained first and second-year medical, nursing, and pharmacy students, aided by a script and interpreters. Patient knowledge of HBV was evaluated at three points: before education, after the initial visit, and at one-month follow-up. Student-led education produced improved knowledge of HBV transmission, prevention, and management, which was retained 1 month after education for 52 patients tracked through time. Mean scores on an HBV knowledge survey improved from 56.4 % (SD = 15.2 %) at baseline to 66.6 % (SD = 15.1 %) after education, and 68.3 % (SD = 15.2 %) after one month. There was a statistically significant difference between the first and second (paired T test, p < 0.001) and the first and third tests (paired T test, p < 0.001), but no difference between the second and third tests (paired T test, p = 0.45). Multivariate analysis demonstrated that retention was correlated with patient educational background but independent of patient age, gender, income, primary language and number of years lived in the United States. Our study suggests that trained health professional students can effectively impart health knowledge that is retained by patients for at least 1 month. These results warrant consideration of student-led educational sessions at SRCs as a promising community health education model.


Student-run clinic Health education Cross-cultural medicine Knowledge retention Hepatitis B 


  1. 1.
    Simpson, S. A., & Long, J. A. (2007). Medical student-run health clinics: Important contributors to patient care and medical education. Journal of General Internal Medicine, 22(3), 352–356.PubMedCrossRefGoogle Scholar
  2. 2.
    Geller, S., Taylor, B. M., & Scott, H. D. (2004). Free clinics helping to patch the safety net. Journal of Health Care for the Poor and Underserved, 15(1), 42–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Nadkarni, M. M., & Philbrick, J. T. (2005). Free clinics: A national survey. The American journal of the medical sciences, 330(1), 25–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Rodríguez, M. A., Bustamante, A. V., & Ang, A. (2009). Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. Journal of General Internal Medicine, 24(Suppl 3), 508–513.PubMedCrossRefGoogle Scholar
  5. 5.
    Ayanian, J. Z., Weissman, J. S., Schneider, E. C., Ginsburg, J. A., & Zaslavsky, A. M. (2000). Unmet health needs of uninsured adults in the United States. The journal of the American Medical Association, 284(16), 2061–2069.CrossRefGoogle Scholar
  6. 6.
    Butala, N. M., Murk, W., Horwitz, L. I., et al. (2012). What is the quality of preventive care provided in a student-run free clinic? Journal of Health Care for the Poor and Underserved, 23(1), 414–424.PubMedCrossRefGoogle Scholar
  7. 7.
    Liberman, K. M., Meah, Y. S., Chow, A., et al. (2011). Quality of mental health care at a student-run clinic: care for the uninsured exceeds that of publicly and privately insured populations. Journal of Community Health, 36(5), 733–740.PubMedCrossRefGoogle Scholar
  8. 8.
    Ryskina, K. L., Meah, Y. S., & Thomas, D. C. (2009). Quality of diabetes care at a student-run free clinic. Journal of Health Care for the Poor and Underserved, 20(4), 969–981.PubMedCrossRefGoogle Scholar
  9. 9.
    Lough, L. E., Ebbert, J. O., & McLeod, T. G. (2011). Evaluation of a student-run smoking cessation clinic for a medically underserved population. BMC Research Notes, 4, 55.PubMedCrossRefGoogle Scholar
  10. 10.
    Weiner, E. A., Billamay, S., Partridge, J. C., & Martinez, A. M. (2011). Antenatal education for expectant mothers results in sustained improvement in knowledge of newborn care. Journal of Perinatology: Official Journal of the California Perinatal Association, 31(2), 92–97.CrossRefGoogle Scholar
  11. 11.
    Yvonne Chan, Y.-F., Nagurka, R., Richardson, L. D., et al. (2010). Effectiveness of stroke education in the emergency department waiting room. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association, 19(3), 209–215.CrossRefGoogle Scholar
  12. 12.
    Devins, G. M., Hollomby, D. J., Barré, P. E., et al. (2000). Long-term knowledge retention following predialysis psychoeducational intervention. Nephron, 86(2), 129–134.PubMedCrossRefGoogle Scholar
  13. 13.
    Taylor, V. M., Hislop, T. G., Tu, S.-P., et al. (2009). Evaluation of a hepatitis B lay health worker intervention for Chinese Americans and Canadians. Journal of Community Health, 34(3), 165–172.PubMedCrossRefGoogle Scholar
  14. 14.
    Kandula, N. R., Malli, T., Zei, C. P., Larsen, E., & Baker, D. W. (2011). Literacy and retention of information after a multimedia diabetes education program and teach-back. Journal of Health Communication, 16(Suppl 3), 89–102.PubMedCrossRefGoogle Scholar
  15. 15.
    Williams, A., Lindsell, C., Rue, L., & Blomkalns, A. (2007). Emergency department education improves patient knowledge of coronary artery disease risk factors but not the accuracy of their own risk perception. Preventive Medicine, 44(6), 520–525.PubMedCrossRefGoogle Scholar
  16. 16.
    Sobel, R. M., Paasche-Orlow, M. K., Waite, K. R., et al. (2009). Asthma 1–2-3: A low literacy multimedia tool to educate African American adults about asthma. Journal of Community Health, 34(4), 321–327.PubMedCrossRefGoogle Scholar
  17. 17.
    Volk, R. J., Spann, S. J., Cass, A. R., & Hawley, S. T. (2003). Patient education for informed decision making about prostate cancer screening: A randomized controlled trial with 1-year follow-up. Annals of Family Medicine, 1(1), 22–28.PubMedCrossRefGoogle Scholar
  18. 18.
    Witmer, A., Seifer, S. D., Finocchio, L., Leslie, J., & O’Neil, E. H. (1995). Community health workers: Integral members of the health care work force. American Journal of Public Health, 85(8 Pt 1), 1055–1058.PubMedCrossRefGoogle Scholar
  19. 19.
    Hill-Briggs, F., Batts-Turner, M., Gary, T. L., et al. (2007). Training community health workers as diabetes educators for urban African Americans: value added using participatory methods. Progress in Community Health Partnerships: Research, Education, and Action, 1(2), 185–194.CrossRefGoogle Scholar
  20. 20.
    Satterfield, D., Burd, C., Valdez, L., Hosey, G., & Shield, J. E. (2002). The “in-between people”: Participation of community health representatives in diabetes prevention and care in American Indian and Alaska native communities. Health Promotion Practice, 3(2), 166–175.Google Scholar
  21. 21.
    Zuvekas, A., Nolan, L., Tumaylle, C., & Griffin, L. (1999). Impact of community health workers on access, use of services, and patient knowledge and behavior. The Journal of Ambulatory Care Management, 22(4), 33–44.PubMedGoogle Scholar
  22. 22.
    Wu, C. A., Lin, S. Y., So, S. K., & Chang, E. T. (2007). Hepatitis B and liver cancer knowledge and preventive practices among Asian Americans in the San Francisco Bay Area, California. Asian Pacific Journal of Cancer Prevention, 8(1), 127–134.PubMedGoogle Scholar
  23. 23.
    Levy, J. D., Nguyen, G. T., & Nguyen, E. T. (2010). Factors influencing the receipt of hepatitis B vaccination and screenings in Vietnamese Americans. Journal of Health Care for the Poor and Underserved, 21(3), 851–861.PubMedCrossRefGoogle Scholar
  24. 24.
    Taylor, V. M., Yasui, Y., Burke, N., et al. (2004). Hepatitis B testing among Vietnamese American men. Cancer Detection and Prevention, 28(3), 170–177.PubMedCrossRefGoogle Scholar
  25. 25.
    Taylor, V. M., Yasui, Y., Burke, N., et al. (2005). Hepatitis B knowledge and testing among Vietnamese-American women. Ethnicity and Disease, 15(4), 761–767.PubMedGoogle Scholar
  26. 26.
    Weinbaum, C. (2008). MMWR Recomm Rep. CDC.Google Scholar
  27. 27.
    2008 Population Estimates. (n.d.). US Census Bureau, Population Division. Retrieved from
  28. 28.
    Taylor, V. M., Tu, S.-P., Woodall, E., et al. (2006). Hepatitis B knowledge and practices among Chinese immigrants to the United States. Asian Pacific Journal of Cancer Prevention, 7(2), 313–317.PubMedGoogle Scholar
  29. 29.
    Lai, C. J., Nguyen, T. T., Hwang, J., et al. (2007). Provider knowledge and practice regarding hepatitis B screening in Chinese-speaking patients. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 22(1), 37–41.CrossRefGoogle Scholar
  30. 30.
    Coronado, G. D., Taylor, V. M., Tu, S.-P., et al. (2007). Correlates of hepatitis B testing among Chinese Americans. Journal of Community Health, 32(6), 379–390.PubMedCrossRefGoogle Scholar
  31. 31.
    Nguyen, T. T., Taylor, V., Chen, M. S., Jr, et al. (2007). Hepatitis B awareness, knowledge, and screening among Asian Americans. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 22(4), 266–272.CrossRefGoogle Scholar
  32. 32.
    Thompson, M. J., Taylor, V. M., Jackson, J. C., et al. (2002). Hepatitis B knowledge and practices among Chinese American women in Seattle, Washington. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 17(4), 222–226.Google Scholar
  33. 33.
    Sheu, L. C., Toy, B. C., Kwahk, E., et al. (2010). A model for interprofessional health disparities education: Student-led curriculum on chronic hepatitis B infection. Journal of General Internal Medicine, 25(Suppl 2), S140–S145.PubMedCrossRefGoogle Scholar
  34. 34.
    Balfour, L., Kowal, J., Corace, K. M., et al. (2009). Increasing public awareness about hepatitis C: Development and validation of the brief hepatitis C knowledge scale. Scandinavian Journal of Caring Sciences, 23(4), 801–808.PubMedCrossRefGoogle Scholar
  35. 35.
    Ananth, P., & Koopman, C. (2003). HIV/AIDS knowledge, beliefs, and behavior among women of childbearing age in India. AIDS Education and Prevention: Official Publication of the International Society for AIDS Education, 15(6), 529–546.CrossRefGoogle Scholar
  36. 36.
    Sheu, L. C., Zheng, P., Coelho, A. D., et al. (2011). Learning through service: Student perceptions on volunteering at interprofessional hepatitis B student-run clinics. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 26(2), 228–233. doi:10.1007/s13187-010-0142-6.CrossRefGoogle Scholar
  37. 37.
    Kripalani, S., & Weiss, B. D. (2006). Teaching about health literacy and clear communication. Journal of General Internal Medicine, 21(8), 888–890.PubMedCrossRefGoogle Scholar
  38. 38.
    Castro, C. M., Wilson, C., Wang, F., & Schillinger, D. (2007). Babel babble: Physicians’ use of unclarified medical jargon with patients. American journal of health behavior, 31(Suppl 1), S85–S95.PubMedCrossRefGoogle Scholar
  39. 39.
    Doak, C. C., Doak, L. G., Friedell, G. H., & Meade, C. D. (1998). Improving comprehension for cancer patients with low literacy skills: Strategies for clinicians. A Cancer Journal for Clinicians, 48(3), 151–162.CrossRefGoogle Scholar
  40. 40.
    Williams, N., & Ogden, J. (2004). The impact of matching the patient’s vocabulary: A randomized control trial. Family Practice, 21(6), 630–635.PubMedCrossRefGoogle Scholar
  41. 41.
    Burkell, J. (2004). What are the chances? Evaluating risk and benefit information in consumer health materials. Journal of the Medical Library Association, 92(2), 200–208.PubMedGoogle Scholar
  42. 42.
    Whittemore, R. (2007). Culturally competent interventions for Hispanic adults with type 2 diabetes: a systematic review. Journal of transcultural nursing: official journal of the Transcultural Nursing Society/Transcultural Nursing Society, 18(2), 157–166.CrossRefGoogle Scholar
  43. 43.
    Hawthorne, K., Robles, Y., Cannings-John, R., & Edwards, A. G. K. (2010). Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabetic Medicine: A Journal of the British Diabetic Association, 27(6), 613–623.CrossRefGoogle Scholar
  44. 44.
    Khunti, K., Camosso-Stefinovic, J., Carey, M., Davies, M. J., & Stone, M. A. (2008). Educational interventions for migrant South Asians with Type 2 diabetes: A systematic review. Diabetic Medicine: A Journal of the British Diabetic Association, 25(8), 985–992.CrossRefGoogle Scholar
  45. 45.
    Bailey, E. J., Cates, C. J., Kruske, S. G., et al. (2009). Culture-specific programs for children and adults from minority groups who have asthma. Cochrane database of systematic reviews (Online), (2), CD006580.Google Scholar
  46. 46.
    Hill, J., Bird, H., & Johnson, S. (2001). Effect of patient education on adherence to drug treatment for rheumatoid arthritis: A randomised controlled trial. Annals of the Rheumatic Diseases, 60(9), 869–875.PubMedGoogle Scholar
  47. 47.
    Schaffer, S. D., & Tian, L. (2004). Promoting adherence: Effects of theory-based asthma education. Clinical Nursing Research, 13(1), 69–89.PubMedCrossRefGoogle Scholar
  48. 48.
    McWilliams, D. B., Jacobson, R. M., Van Houten, H. K., Naessens, J. M., & Ytterberg, K. L. (2008). A program of anticipatory guidance for the prevention of emergency department visits for ear pain. Archives of Pediatrics and Adolescent Medicine, 162(2), 151–156.PubMedCrossRefGoogle Scholar
  49. 49.
    Barr, R. G., Rivara, F. P., Barr, M., et al. (2009). Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trial. Pediatrics, 123(3), 972–980.PubMedCrossRefGoogle Scholar
  50. 50.
    Moon, R. Y., Oden, R. P., & Grady, K. C. (2004). Back to sleep: An educational intervention with women, infants, and children program clients. Pediatrics, 113(3), 542–547.PubMedCrossRefGoogle Scholar
  51. 51.
    Cabana, M. D., & Le, T. T. (2005). Challenges in asthma patient education. The Journal of Allergy and Clinical Immunology, 115(6), 1225–1227.PubMedCrossRefGoogle Scholar
  52. 52.
    Gold, D. T., & McClung, B. (2006). Approaches to patient education: emphasizing the long-term value of compliance and persistence. The American Journal of Medicine, 119(4 Suppl 1), S32–S37.PubMedCrossRefGoogle Scholar
  53. 53.
    Vanderberg-Dent, S. (2000). Part II. Challenges in educating patients. Disease-a-month, 46(12), 798–810.PubMedCrossRefGoogle Scholar
  54. 54.
    Glascoe, F. P., Oberklaid, F., Dworkin, P. H., & Trimm, F. (1998). Brief approaches to educating patients and parents in primary care. Pediatrics, 101(6), E10.PubMedCrossRefGoogle Scholar
  55. 55.
    Schillinger, D., Piette, J., Grumbach, K., et al. (2003). Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine, 163(1), 83–90.PubMedCrossRefGoogle Scholar
  56. 56.
    Sudore, R. L., & Schillinger, D. (2009). Interventions to improve care for patients with limited health literacy. Journal of Clinical Outcomes Management, 16(1), 20–29.PubMedGoogle Scholar
  57. 57.
    Johnson, A., & Sandford, J. (2005). Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home: Systematic review. Health Education Research, 20(4), 423–429.PubMedCrossRefGoogle Scholar
  58. 58.
    Skinner, C. S., Campbell, M. K., Rimer, B. K., Curry, S., & Prochaska, J. O. (1999). How effective is tailored print communication? Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 21(4), 290–298.CrossRefGoogle Scholar
  59. 59.
    Meilleur, K. G., & Littleton-Kearney, M. T. (2009). Interventions to improve patient education regarding multifactorial genetic conditions: A systematic review. American Journal of Medical Genetics Part A, 149A(4), 819–830.PubMedCrossRefGoogle Scholar
  60. 60.
    Jeste, D. V., Dunn, L. B., Folsom, D. P., & Zisook, D. (2008). Multimedia educational aids for improving consumer knowledge about illness management and treatment decisions: A review of randomized controlled trials. Journal of Psychiatric Research, 42(1), 1–21.PubMedCrossRefGoogle Scholar
  61. 61.
    Trevena, L. J., Davey, H. M., Barratt, A., Butow, P., & Caldwell, P. (2006). A systematic review on communicating with patients about evidence. Journal of Evaluation in Clinical Practice, 12(1), 13–23.PubMedCrossRefGoogle Scholar
  62. 62.
    Wofford, J. L., Smith, E. D., & Miller, D. P. (2005). The multimedia computer for office-based patient education: A systematic review. Patient Education and Counseling, 59(2), 148–157.PubMedCrossRefGoogle Scholar
  63. 63.
    Volk, R. J., Cass, A. R., & Spann, S. J. (1999). A randomized controlled trial of shared decision making for prostate cancer screening. Archives of Family Medicine, 8(4), 333–340.PubMedCrossRefGoogle Scholar
  64. 64.
    Beranova, E., & Sykes, C. (2007). A systematic review of computer-based softwares for educating patients with coronary heart disease. Patient Education and Counseling, 66(1), 21–28.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • David Ouyang
    • 1
  • Neal Yuan
    • 1
  • Leslie Sheu
    • 2
  • Gary Lau
    • 3
  • Cheng Chen
    • 4
  • Cindy J. Lai
    • 2
  1. 1.School of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  3. 3.School of PharmacyUniversity of CaliforniaSan FranciscoUSA
  4. 4.Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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