Cluster-Randomized Trial to Increase Hepatitis B Testing among Koreans in Los Angeles

Abstract

Background In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared to the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently sub-optimal. Methods We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews. Results We recruited 1123 individuals, 18-64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, p < .001), with 19% of intervention and 6% of control group participants reporting a HBV test. Conclusion Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae. Impact The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups.

Efficacy of a community‐based participatory and multilevel intervention to enhance hepatitis B virus screening and vaccination in underserved Korean Americans

“…These differences may help to explain why our study achieved a significantly higher screening rate at 6 months of followup compared with other studies with various Asian American ethnic groups, in which screening rates among intervention group participants were <40%. 24,[28][29][30] The current study has several unique strengths that we believe led to the remarkably robust effect. First, the CBPR program was built on a well-established strong partnership between the CAH and Korean churches of the ACHC.…”

“…Second, the intervention approach used in the current study addressed both individual‐level and system‐level barriers. Compared with previous studies that focused primarily on individual education and motivation, the current study not only included intensive community education and direct involvement with community leaders in planning and organization, but also incorporated system‐based components, specifically patient navigation services (transportation assistance, appointment scheduling, language translation) and the active engagement of health care providers. The substantial barriers to health care access faced by Korean Americans include limited English proficiency, uninsured or underinsured status, low income, and a lack of familiarity with the US health care system .…”

“…To the best of our knowledge, the current study is one of the first large‐scale, cluster randomized, church‐based intervention trials aimed at improving HBV screening among Korean Americans. To the our knowledge, only one study to date has evaluated the efficacy of a church‐based intervention to enhance liver cancer‐related HBV testing among Korean individuals in Los Angeles . Although the intervention was found to be significantly effective compared with the control condition, the rate of HBV testing at the 6‐month follow‐up was only 19%, leaving room for improvement.…”

Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: Converging incidence in males and females

“…In a community‐based, randomized controlled trial among Hmong using bilingual/bicultural lay health workers, 24% of intervention participants reported receipt of HBV testing compared with 10% of controls . A church‐based, randomized controlled trial among Koreans with sessions led by lay health educators resulted in 19% of intervention participants reporting HBV testing, compared with 6% of controls . A study among Vietnamese Americans found that those who had received a physician's recommendation or requested HBV testing were 4 and 8 times more likely, respectively, to receive testing, indicating the need for both provider and patient education .…”

“…134 A church-based, randomized controlled trial among Koreans with sessions led by lay health educators resulted in 19% of intervention participants reporting HBV testing, compared with 6% of controls. 135 A study among Vietnamese Americans found that those who had received a physician's recommendation or requested HBV testing were 4 and 8 times more likely, respectively, to receive testing, indicating the need for both provider and patient education. 136 As such, health system-based interventions also have the potential to improve HBV testing by leveraging the importance of provider recommendation and integrating electronic medical records.…”