Integrating theory into community interventions to reduce liver cancer disparities: The Health Behavior Framework

Bastani, Roshan; Glenn, Beth A.; Taylor, Vicky; Chen, Moon S.; Nguyen, Tung T.; Stewart, Susan L.; Maxwell, Annette E.

doi:10.1016/j.ypmed.2009.08.010

Cited by 95 publications

(98 citation statements)

References 28 publications

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“…1), based on the Health Behavior Framework, to guide selection of relevant variables for survey development. (17,18) The survey took approximately 20 minutes to complete and was divided into four sections: (1) knowledge about HCC, (2) potential barriers to HCC surveillance completion, (3) patient attitudes, and (4) demographic information. The first section assessed level of knowledge and consisted of 12 true-false questions with three domains: five questions regarding HCC risk and need for surveillance, four questions about surveillance logistics and effectiveness, and three questions about HCC treatment and prognosis.…”

Section: Survey Development and Administrationmentioning

confidence: 99%

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Farvardin

Patel

Khambaty³

et al. 2016

Hepatology

145

130

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Over 20% of patients with cirrhosis are nonadherent with hepatocellular carcinoma (HCC) surveillance recommendations; however, few studies have evaluated the impact of patient-level factors on surveillance receipt. We characterized the association between HCC surveillance receipt and patient knowledge, attitudes, and perceived barriers in a racially diverse and socioeconomically disadvantaged cohort of patients with cirrhosis. Patients with cirrhosis followed at a large urban hospital were invited to complete a survey about HCC surveillance between August 2014 and December 2015. Multivariable logistic regression was performed to identify factors associated with HCC surveillance receipt during the 12-month period preceding and 6-month period after survey administration. We achieved a response rate of 71.8% (n = 541 of 753). Patients demonstrated high levels of HCC-related knowledge (summary score, 77.7%); however, 48.6% believed that eating a healthy diet precluded the need for HCC surveillance, and 34.0% believed that HCC surveillance was not necessary if they had a normal physical exam and/or lacked clinical symptoms. Patients expressed worry about developing and dying from HCC, but nearly half (49.9%) of patients reported barriers to receiving HCC surveillance, including difficulty with the scheduling process (30.5%), costs of surveillance testing (25.3%), and transportation difficulties (17.3%). HCC surveillance receipt was significantly higher in patients who knew cirrhosis is a risk factor for developing HCC (odds ratio [OR], 3.09; 95% confidence ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO: Amit G. Singal, M.D., M.S., Division of Digestive and Liver Diseases, UT Southwestern Medical Center, 5959 Harry Hines Boulevard, POB 1, Suite 420, amit.singal@utsouthwestern.edu,. * These authors contributed equally to this work and are co-first authors.Potential conflict of interest: Dr. Singal consults for and is on the speakers' bureau for Bayer. Dr. Yopp is on the speakers' bureau for Bayer and received grants from Novartis and Peregrine.Author names in bold designate shared co-first Although provider recommendation is reported to be a strong predictor for HCC surveillance, (9) patient-level factors may also play an important role in surveillance underuse. In prospective cohort studies, nearly 1 in 5 patients were nonadherent with provider recommendations for HCC surveillance. (10,11) The cancer-screening literature has applied theoretical models of behavior change and demonstrated that patients' poor knowledge, negative attitudes, or perceived barriers to cancer screening may be associated with lower screening rates. (12,13) However, most studies evaluating HCC surveillance correlates have primarily focused on patient sociodemographic and clinical characteristics. (7,14) The effect of theory-based, patient-reported psychosocial factors on HCC surveillance completion has not been quantified. A better understanding of patient knowledge, attitudes, and barriers, particularly among low-income minorities, i...

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Section: Survey Development and Administrationmentioning

confidence: 99%

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Farvardin

Patel

Khambaty³

et al. 2016

Hepatology

145

130

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“…The development of the questionnaire and selection of the study variables were guided by the theoretical perspective of the Health Behavior Framework [31,32]. Study variables included known risk factors for liver disease, such as alcohol consumption, weight and height to determine body mass index (BMI), waist circumference, history of diabetes, as well as history of HBV and HCV infection.…”

Section: Study Design and Populationmentioning

confidence: 99%

Risk Factors for Liver Disease and Associated Knowledge and Practices Among Mexican Adults in the US and Mexico

et al. 2011

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Latinos in the US are disproportionately affected by chronic liver disease, which is the sixth most common cause of death among this group. In Mexico, cirrhosis and other liver diseases are the fourth leading cause of general mortality. The objective of this study was to contrast the liver disease risk factors, knowledge, and prevention practices reported among separate samples of Mexicans living in Los Angeles, CA and in Cuernavaca, Mexico. We assessed the prevalence of specific risk factors (body mass index, waist circumference, and alcohol consumption), the level of knowledge about liver disease in general, hepatitis B (HBV), and hepatitis C (HCV), as well as prevention activities such as screening and vaccination. Data were collected from in-person interviews and anthropometric measures obtained from Mexican adults aged 18-70 years. Chi-square and t tests were used to compare the results between groups. Numerous similarities were observed in the bi-national samples, including high prevalence of obesity, abdominal obesity, and high levels of alcohol consumption. Most participants in both countries recognized that excessive alcohol consumption is a risk factor for liver disease, but only 60% correctly identified hepatitis C, being overweight or obese, or having diabetes as risk factors. Few participants reported having been screened for HBV or HCV, vaccinated for HBV, or having the intention of getting screened for HBV or HCV. US participants reported significantly higher levels of prevention activities and screening intentions than those in Mexico. Identifying the specific risk factors, levels of knowledge and prevention activities that affect specific racial/ethnic populations is important in order to effectively target efforts to prevent liver disease.

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“…The intervention was based on the Health Behavior Framework (28), which represents a synthesis of constructs from some of the major theoretical formulations in the area of health behavior (29)(30)(31)(32)(33)(34)(35) and in addition considers characteristics of the provider and the health care setting (36,37), as well as larger community and societal influences (38,39).…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Low-Income Women with Abnormal Breast Findings: Results of a Randomized Trial to Increase Rates of Diagnostic Resolution

Bastani

Mojica

Berman

et al. 2010

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Timely diagnostic resolution of abnormal breast findings represents a critical step in efforts to reduce breast cancer morbidity and mortality. Yet, follow-up rates among resource poor populations are not optimal. Efforts to mitigate this disparity are needed. We report results of a randomized trial assessing the effectiveness of a patient support and navigation intervention in increasing timely diagnostic resolution of abnormal breast findings among indigent women.Methods: Women (n = 1,708) diagnosed with a breast abnormality at two public hospitals were randomized to an intervention or control group. The intervention, delivered through telephone, involved one call from a professional health worker and multiple calls from a lay health worker. The outcome, timely diagnostic resolution, defined as receipt of a definitive diagnosis (malignant or benign) within 6 months of the index referral, was assessed through medical chart audit.Results: Intent-to-treat analyses revealed no significant effect of the intervention on timely diagnostic resolution. Diagnostic resolution rates were 55% and 56%, respectively, in the intervention and control arms. The significant predictors were method of abnormality identification (odds ratio = 1.50) and location of first scheduled appointment (odds ratio = 0.62).Conclusions: The intervention was not effective in creating change within the County health system. Achieving optimum diagnostic follow-up may require more intensive interventions than the one tested. In addition, system-level rather than patient-level interventions may hold more promise.Impact: There are no randomized trials reported in the literature testing interventions to increase diagnostic follow-up of breast abnormalities. Future research might test patient and system-level interventions that can be sustained beyond the study period. Cancer Epidemiol Biomarkers Prev; 19(8); 1927-36. ©2010 AACR.

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Integrating theory into community interventions to reduce liver cancer disparities: The Health Behavior Framework

Cited by 95 publications

References 28 publications

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Patient‐reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis

Risk Factors for Liver Disease and Associated Knowledge and Practices Among Mexican Adults in the US and Mexico

Low-Income Women with Abnormal Breast Findings: Results of a Randomized Trial to Increase Rates of Diagnostic Resolution

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