Risk Perceptions and Barriers to Hepatitis B Screening and Vaccination among Vietnamese Immigrants

Abstract

Hepatitis B (HBV) infection plays a primary role in the development of liver cancer, contributing to nearly 80% of liver cancer cases. Vietnamese males have the highest incidence of liver cancer of any ethnic group, and HBV infection is a serious and prevalent health problem among Vietnamese immigrants. Guided by the Health Belief Model framework, the purpose of the present study was to assess levels of perceived risk, severity, barriers and benefits, and cues to action in HBV screening and vaccination in relation to actual screening and vaccination behavior in a sample of Vietnamese adults. The study consisted of 359 Vietnamese adults residing in Pennsylvania and New Jersey. The majority of participants were immigrants (98.1%) and had low socio-economic and educational status. Only 8.8% of participants reported being screened and 7.3% vaccinated for HBV. Participants who had been screened reported feeling at higher risk and perceived HBV infection to be more likely to lead to liver cancer and death than those who had not been screened. In addition, participants who had been screened reported fewer perceived barriers and more cues to action than unscreened participants. Compared to participants who had been vaccinated, unvaccinated participants were more likely to report feeling healthy and a lack of knowledge about where to obtain HBV testing as barriers. Multivariate logistic regression analyses indicated that perceived barriers were negatively associated with screening behavior as well as vaccination behavior. These results suggest that community-based, culturally appropriate interventions for Vietnamese Americans should directly address barriers to screening and vaccination in order to enhance screening and vaccination rates in this underserved population.

Using Survey Results Regarding Hepatitis B Knowledge, Community Awareness and Testing Behavior Among Asians to Improve the San Francisco Hep B Free Campaign

“…Screening levels among Asians have also been low, ranging from 9 to 55% [11][12][13]. In one study conducted among Asian in the San Francisco Bay Area, two-thirds of those who were chronically infected did not know their infection status [14].…”

Sociodemographic Characteristics, Knowledge and Prevalence of Viral Hepatitis Infection Among Vietnamese Americans at Community Screenings

“…Vietnam is the third leading country of birth for chronic hepatitis B among immigrants in the U.S. and is estimated to account for 11% of chronic hepatitis B cases in the U.S. from 1974–2008 (2). HBV screening programs targeting the AAPI population have existed over the last decade, but the majority of the screening programs have almost always been of Chinese ethnicity, with few Vietnamese participants (3,4). …”

Factors Associated with Hepatitis B Knowledge Among Vietnamese Americans: A Population-Based Survey

“…Incorrect knowledge about the modes of HBV transmission can lead to misguided preventive behaviors and continued stigma against those with HBV [23]. Concern about social stigma has been a documented barrier to HBV screening, diagnosis, and treatment: respondents face fear and shame regarding transmission of HBV to their loved ones and discrimination in the workplace or school [18,25,27,28]. For example, the high rate of participants incorrectly believing that HBV could be spread by sharing food, drink, or utensils demonstrates the high level of distress regarding the contagiousness of HBV, which can hinder open discussions regarding HBV.…”