Health Care Worker Visits Increase Screening for Hepatitis B among Hmong Americans

Newswise — In the first study of its kind, lay health workers were effective in increasing screening rates for hepatitis B virus (HBV) and enhancing knowledge about the disease among a group of Asian Americans, known as the Hmong, UC Davis researchers have found. The study was published online today in Cancer Epidemiology, Biomarkers & Prevention.

Hmong Americans, who originate from the mountainous areas of Laos, are at elevated risk for chronic hepatitis B—the major risk factor for liver cancer. They’re also at greater risk than either white or other Asian Americans for poor outcomes from liver cancer.

Although Hmong Americans often have health insurance, cultural and language barriers often prevent their access to good health care and adequate screening for hepatitis B and liver cancer, according to Moon Chen Jr. a professor and associate director for cancer control at UC Davis, who led the research effort.

“Compared to other Asian Americans, liver cancer tends to be found at a later stage among the Hmong, and the survival rate is very low. While the overall survival rate for liver cancer is 10 percent, Hmong people who are diagnosed with the disease usually live for less than a year, and often for as little as a month or two,” said Chen.

“We wanted to decrease the probability of earlier death from liver cancer among the Hmong and increase the probability of earlier detection,” said Chen, who is also principal investigator for the Asian American Network for Cancer Awareness Research and Training (AANCART), the National Cancer Institute’s National Center for Reducing Asian American Cancer Health Disparities.

In the study, 260 Hmong residents of Sacramento were randomly assigned to two groups—one group received home-based health education about hepatitis B and liver cancer during two visits from workers fluent in Hmong and the Hmong culture and the second group learned about healthy nutrition and physical activity. The healthcare workers also assessed the participants’ knowledge of hepatitis B and liver cancer during their first visit.

Six months later, Hmong subjects who received health education about hepatitis B and liver cancer were more likely to report being screened for HBV. Twenty-four percent of Hmong subjects who learned about hepatitis B and liver cancer were later screened for HBV in contrast to just 10 percent of those who learned about healthy nutrition and physical activity.

Hmong subjects who learned about hepatitis B and liver cancer were also more likely to show significantly greater knowledge about HBV than the control group six months after the health workers’ first visit.

Chronic hepatitis B is endemic in Asia, parts of Africa and Alaska, according to the Centers for Disease Control and Prevention. However, the concept of an infectious disease such as hepatitis B is foreign to the Hmong, since there are few terms in their language for biological agents that are not visible to the naked eye. Their limited English proficiency and cultural hesitation to deal with the American health care system also make it more difficult for the Hmong to receive recommended screenings and timely diagnoses for diseases such as liver cancer, according to Chen.

By using lay educators familiar with both the Hmong culture and language, and training them in health concepts about hepatitis B and liver cancer, the UC Davis researchers were able to surmount some of the usual obstacles to HBV screening among the Hmong, Chen said. The health workers were also recruited from two respected organizations in the Hmong Sacramento community – the Hmong Women’s Heritage Association and the Hmong Cultural Council of Butte County — which increased the probability that the educators would be welcomed into the homes of the Hmong, said Dao Fang, project manager for the UC Davis study.

“It’s often difficult for the Hmong to get good medical care -- not only because of their limited English proficiency, but also because there are often no trained interpreters on hand during medical visits. Hmong patients also don’t know how to request an interpreter,” said Fang, who is also program manager and research director at the Hmong Women’s Heritage Association in Sacramento. “We were able to give the Hmong in our study a brochure that they could use to request a hepatitis B screening during their healthcare visits,” she added.

Although the health care worker visits boosted screening rates for hepatitis B among the Hmong, using such an approach would require an intensive effort, Chen acknowledged. Another effective way to increase the screening rates for HBV among the Hmong would be to work with healthcare providers to encourage them to suggest HBV screenings to their Hmong patients, he noted.

In the UC Davis study, having visited a doctor within the last year or having a doctor suggest hepatitis B screening was a strong predictor of a patient getting screened.

“In this and previous studies we have found that one of the most influential factors in predicting getting screened for HBV is the recommendation of a healthcare provider,” Chen said.

The UC Davis research was funded jointly by the National Cancer Institute’s Center to Reduce Cancer Health Disparities and the National Institute on Minority Health and Health Disparities, grant numbers CA109091-01A1 and U54CA153499.

About the UC Davis Comprehensive Cancer CenterUC Davis Comprehensive Cancer Center is the only National Cancer Institute comprehensive-designated center serving the Central Valley and inland Northern California, a region of more than 6 million people. Its top specialists provide compassionate, comprehensive care for more than 9,000 adults and children every year, and offer patients access to more than 150 clinical trials at any given time. Its innovative research program includes more than 280 scientists at UC Davis and Lawrence Livermore National Laboratory. The unique partnership, the first between a major cancer center and national laboratory, has resulted in the discovery of new tools to diagnose and treat cancer. Through the Cancer Care Network, UC Davis is collaborating with a number of hospitals and clinical centers throughout the Central Valley and Northern California regions to offer the latest cancer-care services. Its community-based outreach and education programs address disparities in cancer outcomes across diverse populations. For more information, visit www.ucdmc.ucdavis.edu/cancer.