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Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial
Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial Hee-Soon Juon, Carol Svào, Frederic Kyên, Eunngươi Park, Sunmin Lee
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Background

This study aimed to lớn evaluate the effect of a lay health worker (LHW) telephone intervention on completing a series of hepatitis B virus (HBV) vaccinations ahy vọng foreign-born Asian Americans in the Baltimore-Washington Metropolichảy area.


Methods

During the period of April 2013 và March 2014, we recruited Asian Americans who were 18 years of age and older in the community-based organizations. Of the 645 eligible participants, 600 (201 Chinese, 198 Korean, 201 Vietnamese) completed a predemo survey and received hepatitis B screening. Based on the screening results, we conducted a randomized controlled trial aước ao those unprotected (HBsAg-/HBsAB-) by assigning them either to lớn an intervention group (n = 124) or control group (n = 108). The intervention group received a list of resources by mails for where lớn get không tính phí vaccinations as well as reminder calls for vaccinations from trained LHWs, while the control group received only danh mục of resources by mail. Seven months after mailing the HBV screening results, trained LHWs followed up with all participants by phone to lớn ask how many of the recommended series of 3 vaccinations they had received: none, 1 or 2, or all 3 (complete). Their self-reported vaccinations were verified with the medical records. Multinomial logistic regressions were used to lớn examine the effect of the LHW intervention. Process evaluation was conducted by asking study participants in the intervention group lớn evaluate the performance of the LHWs.


Results

After seven months, those in the intervention group were more likely to have sầu 1 or more vaccines than the control group, compared khổng lồ the no vaccination group (OR = 3.04, 95% CI, 1.16, 8.00). Also, those in the intervention group were more likely to complete a series of vaccinations than the control group, compared to lớn the no vaccination group (OR = 7.29, 95% CI 3.39, 15.67). The most important barrier preventing them from seeking hepatitis B vaccinations was laông chồng of time khổng lồ get the vaccination. The most important promoters lớn getting vaccinations, ahy vọng those who had vaccinations (n = 89), were our intervention program (70.8%) & self-motivation (49.4%). The majority of participants in the intervention group received the phone calls from LHWs (93%) & almost all of them got the reminder khổng lồ receive vaccines (98%).


Conclusion

The LHW intervention was successful at increasing HBV vaccinations rates aước ao foreign-born Asian Americans. This study suggests that this culturally integrated intervention program may be useful for reducing liver cancer disparities from chronic HBV infection in high risk Asian Americans.


Trial Registration

ClinicalTrials.gov NCT02760537


Citation: Juon H-S, Svào C, Klặng F, Park E, Lee S (2016) Lay Health Worker Intervention Improved Compliance with Hepatitis B Vaccination in Asian Americans: Randomized Controlled Trial. hjwitteveen.com ONE 11(9): e0162683. https://doi.org/10.1371/journal.pone.0162683

Editor: Vincent Wong, The Chinese University of Hong Kong, HONG KONG

Received: June 3, 2016; Accepted: August 24, 2016; Published: September 12, 2016

Data Availability: All relevant data are within the paper & its Supporting Information files.

Funding: This work was supported by the National Cancer Institute (R01CA163805) HJ, & Center for Strategic Scientific Initiatives, National Cancer Institute (5P30CA056036-17). The funders had no role in study design, data collection & analysis, decision lớn publish, or preparation of the manuscript.

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Competing interests: The authors have declared that no competing interests exist.


Introduction

Hepatitis B virus (HBV) infection has become a serious health concern within the Asian American community. While the prevalence of HBV infection is very low among mỏi Whites in the United States (0.1%), as many as 1 in 10 Asian Americans carry the virus, accounting for more than half of U.S. HBV cases <1>. About 65% of infected adults are unaware of their condition because chronic HBV is asymptomatic <2>, yet the silent killer increases the risk of developing serious liver disease later in life. Because HBV disproportionately infects Asian Americans, significant liver cancer disparities exist among them, và they are often diagnosed with late-stage liver cancer, resulting in high mortality rates.

People who are not infected with HBV and who bởi not possess the HBV antitoàn thân should receive sầu a series of 3 vaccinations in 6 months to lớn protect them from the virus <2>. Most importantly, studies have sầu shown that the hepatitis B vaccine as the first anticancer vaccine can protect them from hepatocellular carcinoma (HCC) <3>. Current U.S. policy is universal vaccination of all infants at birth, adolescents, và high-risk adults, such as intravenous drug users or those in cthua trận tương tác with HBV-infected individuals. In its most recent updated recommendation in 2009, the United States Preventive sầu Services Task Force (USPSTF) advised that HBV vaccination is effective at lowering infection risk in high-risk populations <4>. While the cost effectiveness of HBV screening amuốn the general population is under debate <5,6>, HBV vaccination ahy vọng foreign born adult immigrants is considered khổng lồ be vital. A cost-effective sầu analysis comparing several HBV screening và vaccination strategies among mỏi Asian and Pacific Islander adults found a screen, treat, và ring vaccination strategy was highly cost effective sầu <7>. In this approach, everyone was screened by hepatitis B surface antigene (HBsAg) tests lớn determine whether they were chronically infected, & people with cchiến bại contact with infected individuals were given hepatitis B surface antibody (HBsAb) tests & vaccinated if needed. However, as indicated in several community-based studies, the vaccination rate remained low among muốn Asian American adults <8–11>. More than half of Asian American primary care providers reported less than a quarter of their adult Asian patients had received the HBV vaccination series <12>.

Challenges exist in terms of properly informing and educating Asian Americans about HBV screening và vaccination. Therefore, culturally integrated educational strategies are needed to lớn assure that we reach as many Asian Americans as possible. In previous studies, we developed a culturally integrated liver cancer educational program và tested the effectiveness of an intervention program for HBV screening using a cluster randomized controlled kiến thiết. We found that participants in the intervention group significantly increased their HBV knowledge and were more likely to seek HBV screening compared lớn the control group <13,14>.

The Asian American population has been growing rapidly in the United States over the past decade, & a majority (67%) of the current Asian American population is foreign born <15>. In 2010, Asian Americans numbered approximately 14.4 million, accounting for about 5.0% of the U.S. population, và by the year 2050, the Asian American population will be 41 million, accounting for 11% of the U.S. population, based on projected figures <16>. To ensure that Asian Americans receive needed hepatitis B care, it is important to lớn fill knowledge gaps regarding HBV, enhance understanding of risks, và provide appropriate screening & vaccination.

Some studies have sầu addressed ways to prsự kiện HBV infection through various intervention programs <13,14,17–19>. Intervention programs educate high-risk populations about how HBV spreads, how lớn protect against the disease, and how lớn get proper care. Amuốn these intervention programs, the lay health worker (LHW) Model responds khổng lồ the need for effective sầu cancer interventions that reach at-risk underserved populations where traditional outreach efforts have sầu failed <20,21>. A 2002 Institute of Medicine report on racial & ethnic disparities in healthcare recommended using LHWs as well as implementing collaborative sầu interventions và preventive sầu care programs <22>. In the past decade, more studies have examined the benefits of LHW models khổng lồ raise hepatitis B awareness among Asian American communities. For example, a LHW intervention was found to be effective sầu in increasing hepatitis B screening và knowledge among Hmong Americans <23> & Cambodian Americans <17> living in California. A similar study with Chinese Americans found that LHW intervention raised hepatitis B screening knowledge, but it had a very limited impact on screening demo actions <19>. Most LHW studies conducted among mỏi Asian American have focused on increasing hepatitis B knowledge and self-reported screening, but very few have sầu discussed the issue of completion of hepatitis B vaccinations. This gap in the HBV vaccinations among mỏi Asian Americans needs to lớn be filled and evaluated. Also, despite evidence that the LHW interventions improve community outcomes of HBV screening behaviors amuốn Asian Americans, few studies have sầu reported process evaluations for monitoring the implementation of LHW intervention programs.

To address the disparity in hepatitis B care among mỏi the Asian American groups, intervention programs must consider barriers. Reasons for low levels of hepatitis B screening and vaccination aý muốn Asian American adults include low awareness and risk perception, a lack of access lớn health care because of limited insurance coverage và English proficiency <11,24,25>, and cultural biases, such as believing that the consumption of Chinese herbal medicine will prsự kiện acquiring HBV infection <26>. We intover lớn address these barriers in our LHW interventions & provide access to lớn không lấy phí or low-cost hepatitis B vaccinations. We ayên ổn khổng lồ use a culturally-appropriate intervention that will prsự kiện these barriers from becoming rampant. To address the gaps in the evidence, we undertook a study to examine the effectiveness of the LHW phone intervention on completing the series of HBV vaccinations và khổng lồ identify the promoters khổng lồ receiving vaccinations and the barriers preventing vaccinations. We hypotheform size that those in the intervention group are more likely khổng lồ complete vaccinations than those in the control group.

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