Socio-ecological Determinants of Hepatitis B Screening Behavior Among Asians and Pacific Islanders in Philadelphia

Background/Significance – Hepatitis B (HBV) is a life-threatening liver infection and leading cause of liver cancer worldwide, causing 1 million deaths annually. In the U.S., HBV disproportionately affects Asian and Pacific Islanders (APIs), who have high rates of infection but low rates of awareness, diagnosis and vaccination. In Philadelphia, less than 25% of APIs have been screened. Without diagnosis and appropriate care, individuals are at greater risk for disease progression and premature death.

Objective/Purpose – The purpose was to assess multiple factors associated with low screening rates among APIs in Philadelphia. It is important to understand all of the complex factors so we can better target, and enhance the success, of future interventions.

Methods – Both quantitative and qualitative data were collected from APIs residing in Philadelphia to assess barriers to HBV screening through survey data, telephone and in-person, in-language interviews. A needs assessment was conducted among local social service, community and cultural organizations to gain the perspective of those serving Philadelphia API communities.

Results – Results indicate there are multiple socio-economic and cultural barriers to HBV screening among APIs in Philadelphia. Important barriers include lack of time (shift-work), limited transportation, lack of physicians who speak an API language and are easily accessible, and under-insurance. A limited understanding of how to navigate the U.S. health care system (i.e. finding a doctor and making an appointment) is also a barrier. Other barriers included cultural beliefs regarding preventive health, and myths or inaccurate information about HBV infection and treatment.   

Discussion/Conclusions - Results of this study have allowed us to build a socio-ecological model to better understand the multiple factors associated with low HBV screening rates among Philadelphia APIs. Future interventions need to address factors all levels to improve screening rates. Any plan must be culturally competent to enhance outcomes in deficient areas.