Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2017; 23(42): 7626-7634
Published online Nov 14, 2017. doi: 10.3748/wjg.v23.i42.7626
Hepatitis B virus outreach to immigrant population in Greater Boston Area: Key to improving hepatitis B knowledge
Raissa Djoufack, Scarlett Se Yun Cheon, Aisha Mohamed, Fatou Faye, Korka Diouf, Richard Colvin, James Morrill, Ann-Marie Duffy-Keane, Ponni Perumalswami, Gonzague Jourdain, Dahlene Fusco
Raissa Djoufack, Universite des Montagnes, Bangangte 61710, Cameroon
Scarlett Se Yun Cheon, Wellesley College, Wellesley, MA 02481, United States
Aisha Mohamed, Cooper Medical School of Rowan University, Camden, NJ 08103, United States
Fatou Faye, Korka Diouf, Suffolk University, Boston, MA 02108, United States
Richard Colvin, James Morrill, Ann-Marie Duffy-Keane, Dahlene Fusco, Division of General Internal Medicine, MGH, Boston, MA 02114, United States
Ann-Marie Duffy-Keane, MGH Community Health Associates, Revere, MA 02114, United States
Ponni Perumalswami, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Gonzague Jourdain, Institut de Recherche pour le Dé­veloppement, Marseille 13000, France
Gonzague Jourdain, Chiang Mai University, Chiang Mai 50200, Thailand
Gonzague Jourdain, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
Dahlene Fusco, Division of Infectious Disease, Department of Medicine, Vaccine and Immunotherapy Center, MGH, Boston, MA 02129, United States
Dahlene Fusco, Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Djoufack R, Cheon SSY, Mohamed A, Faye F, Diouf K, Colvin R, Morrill J, Duffy-Keane AM, Perumalswami P, Jourdain G and Fusco D all helped conduct this study and contributed to the manuscript; Jourdain G, Fusco D, Djoufack R and Cheon SSY analyzed the data; Fusco D designed this study.
Supported by Gilead Sciences (DNF).
Institutional review board statement: This study was reviewed and approved by the Partners/Massachusetts General Hospital Institutional Review Board.
Informed consent statement: All study participants provided informed verbal consent in native language or in English.
Conflict-of-interest statement: Dahlene Fusco has received support towards this study from Gilead.
Data sharing statement: Verbal consent was obtained; data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dahlene Fusco, MD, PhD, Division of Infectious Diseases, Instructor in Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States. dnfusco@mgh.harvard.edu
Telephone: +1-617-7263813 Fax: +1-617-7267416
Received: July 7, 2017
Peer-review started: July 9, 2017
First decision: July 28, 2017
Revised: August 9, 2017
Accepted: August 25, 2017
Article in press: August 25, 2017
Published online: November 14, 2017
Abstract
AIM

To characterize the understanding of hepatitis B virus (HBV) and determine if outreach improves HBV understanding among Greater Boston Area immigrants.

METHODS

Six outreach sessions were held in various community venues in the Greater Boston Area. Verbal consent was obtained from participants prior to starting each session. Each session included a pre-session questionnaire, followed by a teaching session, and then a post-session questionnaire. In person interpreters were present for translation during the teaching session and assistance for questionnaire completion when needed. The questions were developed based on the HBV clinical experience of physicians who serve largely immigrant populations. Questionnaires included Likert-type scale, open-ended, and true-false questions. All results were anonymous.

RESULTS

One hundred and one people participated in this study. Participants were 30% male with ages ranging from 19 to 87 years. The study population included immigrants from 21 countries, as well as seven United States-born participants. The greatest numbers of participants were from Somalia (44%), Morocco (10%), and Cameroon (8%). Pre session questionnaires revealed that 42% of participants were unaware that HBV can cause cancer, and 50% were unaware that therapies for HBV exist. Our brief teaching intervention led to improved scores on post session questionnaires. For example, at baseline, 58% of participants responded correctly to the question “HBV infection can cause scarring of the liver and liver cancer”, whereas 79% of participants responded correctly after the teaching session (P = 0.01). Furthermore, the mean of total correct answers in the true or false portion of the questionnaire increased from 5.5 to 7.6 (P < 0.001).

CONCLUSION

A teaching session targeting Boston Immigrants at-risk for HBV helped improve scores on HBV knowledge questionnaires. Outreach may empower at-risk patients to pro-actively seek HBV care.

Keywords: Hepatitis B virus, Outreach, Linkage to care, Immigrant, Boston

Core tip: Awareness is the key to the mitigation of transmittable diseases such as hepatitis B virus (HBV). Therefore, characterizing the baseline understanding of HBV, and improving that baseline, are the first steps toward improving HBV linkage to care among at-risk persons. To characterize and improve the baseline understanding of HBV we performed HBV teaching sessions with pre and post session questionnaires in multiple community venues in and around Boston. These sessions revealed that (1) baseline understanding of risks related to HBV are limited; and (2) a brief teaching session can significantly improve understanding of HBV risks.