Hepatitis B in Moroccan-Dutch: a quantitative study into determinants of screening participation

Abstract

BackgroundIn November 2016, the Dutch Health Council recommended hepatitis B (HBV) screening for first-generation immigrants from HBV endemic countries. However, these communities show relatively low attendance rates for screening programmes, and our knowledge on their participation behaviour is limited. We identified determinants associated with the intention to request an HBV screening test in first-generation Moroccan-Dutch immigrants. We also investigated the influence of non-refundable costs for HBV screening on their intention.MethodsOffline and online questionnaires were distributed among first- and second/third-generation Moroccan-Dutch immigrants using respondent-driven sampling. Random forest analyses were conducted to determine which determinants had the greatest impact on (1) the intention to request an HBV screening test on one’s own initiative, and (2) the intention to participate in non-refundable HBV screening at €70,-.ResultsOf the 379 Moroccan-Dutch respondents, 49.3% intended to request a test on their own initiative, and 44.1% were willing to attend non-refundable screening for €70,-. Clarity regarding infection status, not having symptoms, fatalism, perceived self-efficacy, and perceived risk of having HBV were the strongest predictors to request a test. Shame and stigma, fatalism, perceived burden of screening participation, and social influence of Islamic religious leaders had the greatest predictive value for not intending to participate in screening at €70,- non-refundable costs. Perceived severity and possible health benefit were facilitators for this intention measure. These predictions were satisfyingly accurate, as the random forest method retrieved area under the curve scores of 0.72 for intention to request a test and 0.67 for intention to participate in screening at €70,- non-refundable costs.ConclusionsBy the use of respondent-driven sampling, we succeeded in studying screening behaviour among a hard-to-reach minority population. Despite the limitations associated with correlated data and the sampling method, we recommend to (1) incorporate clarity regarding HBV status, (2) stress the risk of an asymptomatic infection, (3) emphasise mother-to-child transmission as the main transmission route, and (4) team up with Islamic religious leaders to help decrease elements of fatalism, shame, and stigma to enhance screening uptake of Moroccan immigrants in the Netherlands.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1034-6) contains supplementary material, which is available to authorized users.

Hepatitis B and C screening needs among different ethnic groups: A population-based study in Amsterdam, the Netherlands

“…Importantly, as emphasized by the World Health Organization, 43 screening and treatment programs for migrant populations should provide accessible options for timely screening and treatment, as there are a number of barriers to detection and treatment of infectious diseases among migrants. 44 Programs should address factors influencing participation in HBV screening, such as stigma and fatalism [45][46][47] and integrate strategies to facilitate access, such as outreach awareness raising. 44 HCV screening for the large ethnic groups in Amsterdam seems unjustified, but combined HBV and HCV screening might still be cost-effective if offered to first-generation migrants of Ghanaian and Surinamese origin.…”

Clustering of chronic hepatitis B screening intentions in social networks of Moroccan immigrants in the Netherlands

“…The value was increased to stimulate peer-recruitment among all new participants. Invitations containing unique and anonymous codes (more details can be found in a previous publication [12]) enabled us to follow who invited whom and to visualise and analyse their social networks. Eligibility criteria included: 1) age ≥ 16 years; 2) born in Morocco and having at least one parent born in Morocco, or born in the Netherlands and having at least one (grand-) parent born in Morocco; and 3) residing in the Netherlands.…”

“…Based on three small regional Dutch studies, the prevalence of chronic HBV among Moroccans, who form the second largest immigrant group in the Netherlands, is low (0.54% [95% CI 0.01-1.07]) but within the range targeted for screening [11]. We chose to target Moroccan immigrants in our pilot study, because of the proven cost-effectiveness and having our existing infrastructure [12,13]. Following the guidelines of Statistics Netherlands, we also define firstgeneration Moroccan immigrants as individuals born in Morocco and having at least one parent born in Morocco, and second-generation Moroccan immigrants as individuals born in the Netherlands and having at least one parent born in Morocco [14].…”

“…Both strategies start with an HBV test (costing EUR 25 (2019)). Since the Dutch health insurance is organised with a compulsory annual amount ("front-end deductible") of EUR 385 (2019) which you have to pay for health services before your health insurance begins to pay, the HBV test is not refundable for those for whom this threshold has not been reached yet with other health care costs [12]. However, Moroccan immigrants show lower participation rates in health-related screening programmes compared to indigenous and other immigrant populations [15][16][17][18].…”

“…Previous qualitative and quantitative research showed that the main reasons for this nonparticipation in HBV screening initiatives were shame and stigma, fatalism (i.e. an attitude of resignation in the face of some future event or events which are thought to be inevitable), and the perceived burden of participating in such a screening [12,13].…”