A mixed-methods evaluation of hepatitis B knowledge, attitudes, and practices among migrant women in Thailand

Abstract

Background Globally 90 % of transmission of Hepatitis B virus (HBV) is from mother-to child and occurs predominantly in resource limited countries where the prevalence of HBV is high. Transmission could be interrupted by timely vaccinations but coverage remains problematic in these areas. Low knowledge or awareness of HBV may play a part in low vaccination coverage. This study examines the provision of antenatal care counselling with a focus on HBV in two different regions of northern Thailand, Sarapee Hospital (SH), Chiang Mai, and Shoklo Malaria Research Unit (SMRU), Tak Province. Methods A mixed-methods sequential explanatory study design was used to evaluate antenatal services for migrants. Cross-sectional knowledge, attitude and practice (KAP) surveys were conducted immediately after counselling at first ANC contact, at 3–6 months after first ANC contact and at delivery. Surveys provided quantitative data, and qualitative methods included observations, focus group discussions (FGD) and in-depth interviews (IDI); analysed thematically to explore concepts of knowledge and understanding, attitude and practice of pregnant women and providers. Results Between September-2019 and May-2020, 757 women participated to KAP surveys, and 31 observations of counselling, 16 FGD and 9 IDI were conducted. KAP surveys showed in spite of low knowledge about HBV transmission, infection, or vaccination (correct response: SH 5.7 %, 9/157; SMRU 34.0 %, 204/600), most women (≥ 93 %, either site) understood they were screened for HBV and were willing to vaccinate infants for HBV. In explaining KAP survey results, qualitative analysis suggests counselling should: use the appropriate language; be tailored to the local health literacy level, provide only pertinent information, be repeated over the antenatal period; and attempt to ensure patient privacy (where possible). Programme effectiveness benefits from positive attitudes to screening and vaccinations and a high level of trust in the providers nevertheless participants provided good suggestions for improvements of the service. Conclusions Limited knowledge of HBV among migrant women can be improved by counselling that emphasizes actionable knowledge such as vaccination schedule. Key improvements to the counselling process include training counsellors to conduct interactive counselling sessions in the woman’s language, using appropriate visual aids and timely repetition over the course of the antenatal period.

Predictive factors of vaccination status, knowledge, attitudes, and practice towards prevention of hepatitis B infection among Bangladeshi people: A cross‐sectional study

“…Furthermore, poor practices may play a vital role in low vaccination rates and increase exposure to the disease as well as their vulnerability to contracting and/or spreading the disease among potential people. 22 The present study findings suggest that more HB‐related health education, public awareness and promotion, and appropriate practice are required to eradicate HBV in Bangladesh. In terms of vaccination status, the current study showed that older participants (aged between 50 and above) received less HB vaccine.…”

Who is protected? Determinants of hepatitis B infant vaccination completion among a prospective cohort of migrant workers in Thailand during the COVID-19 pandemic

“…Between September 10, 2019 and March 30, 2019, 253 women were surveyed, 200 from SMRU and 53 from SH. Results of this survey have been previously documented in detail [ 23 ]. Briefly, age, number of children, and Hepatitis B positivity were not significantly different between the sites (Table 1 ).…”

“…Willingness to vaccinate was previously reported to be unrelated to knowledge about hepatitis B [ 23 ]. In this dataset, there was no association between willingness to vaccinate and actual vaccine completion, which was not explored previously.…”

“…Briefly, a survey of knowledge, attitudes and practice (Additional file 1 ) was adapted from the literature [ 28 ] and administered to women in the first few days postpartum. The survey process and results of all women who participated are reported in detail elsewhere [ 23 ].…”

“…In 2019 a series of knowledge, attitude and practice surveys were conducted at Sarapee hospital (SH) in Chiang Mai, a small hospital that serves the local migrant and Thai populations, and at SMRU clinics for migrant and minority communities in Tak province operated by SMRU (Fig. 1 ) [ 23 ]. Follow-up to determine the rate of vaccine completion was planned at each site, and happened to be disrupted by the COVID-19 pandemic.…”