- Chronic hepatitis B disproportionately affects Asian Americans. Although Asians make up only 4.2% of the total United States (U.S.) population, they account for more than half of those infected with hepatitis B. If left untreated, chronic hepatitis B could lead to cirrhosis, liver damage, and liver cancer. Studies show that the Hmong population in the U.S., who emigrated from Southeast Asia where hepatitis B is endemic, have a high prevalence of hepatitis B, yet knowledge about the disease, as well as, screening and vaccination rates, are low.
Guided by the ecological perspective, the Health Belief Model (HBM), and the Explanatory Models Approach, the purpose of this exploratory study was to examine 1) knowledge and beliefs about hepatitis B infection and transmission; 2) perceptions of risk to hepatitis B; 3) barriers to hepatitis B screening and vaccination; and 4) knowledge of liver cancer among Hmong living in Oregon. This study used a mixed methods approach (i.e., quantitative and qualitative) to collect data from Hmong women and men living in Oregon. Data from 17 key informant and 83 in-depth interviews were analyzed using content analysis techniques.
Results indicated that most in-depth interview participants had heard of the hepatitis B virus (96%) and slightly over half had been screened (53%) and vaccinated (51%). Bivariate analyses showed that education, health insurance, preventive care, doctor’s recommendation, and English proficiency were significantly associated with having been screened for hepatitis B. Only English proficiency was significantly associated with hepatitis B vaccination. In general, more than half of the in-depth interview participants were able to correctly identify most of the routes of hepatitis B transmission; however, there were still large gaps in knowledge. Nearly 40% were unaware that sexual intercourse was a route of transmission, 41% did not know that sharing a toothbrush could spread the virus, and 57% did not know that the virus is not transmitted through coughing. Multivariate logistic regression analyses indicated that the relationship between most HBM components (e.g., perceived susceptibility, perceived benefits) was not associated with screening or vaccination. Qualitative results provided insight into screening and vaccination experiences and Hmong beliefs about liver cancer. In general, in-depth interview participants reported not facing many barriers in getting screened or vaccinated for hepatitis B. Some participants cited that not knowing the testing process or the importance of testing made it difficult to get screened. Participants tended to have fatalistic beliefs about liver cancer and remarked that liver cancer signified death or a disease that was incurable. The findings suggest that Hmong in Oregon have low levels of knowledge about hepatitis B and liver cancer and indicate a need for culturally tailored educational interventions.