Comparative influence of cultural views, social norms, and knowledge on hepatitis B screening among three Asian sub-populations in Maryland

Cultural beliefs are important determinants for health behavior among immigrants. However, few quantitative studies tested the influence of cultural beliefs and behavioral constructs in hepatitis B virus (HBV) screening behavior. The objective of this study is to assess the role of cultural beliefs in screening behavior compared with HBV knowledge and social norms. The Maryland Asian American Liver Cancer Education Program recruited 877 adult Korean, Chinese, and Vietnamese Americans. Multiple logistic regressions analyzed the influence of knowledge of transmission, social norms, and cultural beliefs; controlling for age, gender, socio-economic status and family history of HBV infection. Overall, higher fatalism was significantly associated with less probability of screening (OR:0.97). Among other mutable factors, descriptive norms were the strongest predictor (OR: 1.52), followed by injunctive norms and knowledge. Significant immutable factors included family history and education. Ethnicity-specific analyses demonstrated variations of significant predictors. For Koreans, descriptive and injunctive norms were equally important (OR: 1.46), followed by knowledge. For Chinese, descriptive norms were most important (OR:1.82), followed by injunctive norms and a stronger belief in herbal medicine reduced the odds (OR:0.88). Descriptive norms were the strongest mutable predictor for Vietnamese (OR:1.31), followed by knowledge and belief in herbal medicine. Family history was a significant immutable factor for Vietnamese. The results indicated the importance of social norms and a modest influence of fatalism or belief in herbal medicine in screening behavior. Future intervention should address an individual's knowledge and cultural beliefs, and social norms through community mobilizations. Ethnicity-specific factors should be addressed in interventions.