Awareness, Knowledge, and Misperceptions Related to Nonalcoholic Fatty Liver Disease in a Community Sample of Mexican-Origin Women: A Mixed Methods Study

Abstract

Introduction: Mexican-origin women suffer disproportionate rates of nonalcoholic fatty liver disease (NAFLD) and research on how to tailor NAFLD treatment interventions for this population is lacking.Objectives: The purpose of this study was to assess awareness, knowledge, perceptions, and information sources related to NAFLD in a community-based sample of Mexican-origin women.Methods: This study employed a convergent parallel mixed-methods approach and consisted of a brief questionnaire (n = 194) and interviews (n = 26) among Mexican-origin women recruited from community-based settings including health fairs, churches, and community events. Participants were eligible if they identified as Mexican-origin, had a BMI ≥ 25 kg/m2, were 18–64 years of age, had the ability to speak, read, and write in English and/or Spanish, and provided informed consent. A purposeful sampling approach was used to recruit a subset of women (n = 26) with confirmed liver steatosis indicative of NAFLD (controlled attenuation parameter ≥280 dB/m) who completed the questionnaire. The twenty-six participants then completed one on one, in-depth semi-structured interviews to ascertain their knowledge and understanding of NAFLD.Results: Qualitative findings revealed low awareness of risk factors for liver disease, NAFLD specifically. Knowledge of liver disease tended to center around cirrhosis, a condition many participants reported was prevalent in their families. Quantitative and qualitative findings both found information sources for NAFLD and liver disease to be predominantly friends, family, and media. Interviews revealed a misperception related to NAFLD risk that liver disease was only caused by high alcohol intake.Conclusion: Low levels of NAFLD awareness and knowledge warrant the need for greater efforts to educate the general population, perhaps by integrating NAFLD education into existing type 2 diabetes educational campaigns and prevention interventions. Additionally, further elicitation research conducted in Mexican-origin adults is needed to elucidate key factors within behavioral-theory constructs that can be targeted in future interventions tailored to this unique population.

How Mexicans’ Emotional Responses to Non-Alcoholic Fatty Liver Disease Can Help Inform Culturally Congruent Health Care

“…Previous data from this study sample have documented that Mexicans frequently display the emotion of surprise upon learning NAFLD (Morrill et al, 2021). The surprise that results from novel or unexpected information acts to reorient attention and form memory (Itti & Baldi, 2009; Palm, 2012), thereby informing subsequent action and emotional states (Jang et al, 2015).…”

“…While we previously documented high rates of surprise due to poor access to medical attention, lack of health information, and the common perception that liver disease is always tied to alcohol abuse (Morrill et al, 2021), most participants quickly moved from surprise into the emotional states of fear and hope. Participants’ fear was derived both the gravity of NAFLD and their own potential to progress to the highly fatal conditions of liver cirrhosis and liver cancer as well as the heavy burden NAFLD and other liver disease carry among Mexican-origin people more generally (Flores et al, 2012).…”

“…Here, we highlight four factors to inform effective transcultural NAFLD communication approaches among Mexican-origin populations. First, given that high rates of cirrhosis and alcoholism in Mexico have led to common assumptions that liver disease is primarily caused by alcohol abuse, providers, and public health messaging must work to address these perceptions and make clear that NAFLD afflicts people who do not consume alcohol (Morrill et al, 2021). Second, novel NAFLD risk communication messaging should build upon pre-existing fear of liver disease caused by high levels of exposure to cirrhosis and related mortality, to produce a more impactful message (Myrick & Nabi, 2017).…”

“…As previously reported (Morrill et al, 2021), most participants knew little about NAFLD prior to being recruited for this study. Many participants expressed that the surprising information they received during the study had shifted their understanding of disease risk and motivated them to learn more.…”

The Impact of Racial Disparities on Liver Disease Access and Outcomes

“…An important step toward improving disparities in NAFLD prevalence and outcomes is to improve both patient and provider education regarding the disease. One study of Mexican-American women in Arizona showed that 82.5% had never heard of NAFLD from their doctor [57]. Many participants believed liver disease came from alcohol consumption alone.…”