Addressing chronic hepatitis B in a high risk population: an integrated approach

Introduction: Chronic hepatitis B (CHB) is endemic in most Asian countries, but Hmong migrant populations have a higher prevalence than most (~15%) and the worst outcomes of hepatocellular carcinoma. Therefore, the North Queensland Hmong community represents an important study population for CHB research. After a long history of persecution and resettlement challenges, preventive health care has low priority in the community. However, community leaders support this research because many families were touched by liver disease in the past. The aims are to raise awareness about CHB in the community, increase their confidence in dealing with the health care system, and enable preventive action such as screening, immunization, and monitoring. \ud \ud Methods: Details of the research are continually discussed with community leaders and all written material is checked for acceptability before translation. The project involves 1) the development of an assessment tool based on behavioural theory (including a new model covering psycho-social, cultural, health care, and other factors); 2) a narrative educational intervention incorporating theoretical principles such as perceived threat and efficacy; 3) a community screening program to facilitate preventive behaviours (collaboration with Queensland Health); and 4) post-intervention assessment. \ud \ud Results: Data collection and analyses are still proceeding but early indications suggest low knowledge and awareness of hepatitis B in the community as well as some trust and communication issues related to health care. Further results will point to the most effective ways of overcoming these barriers.\ud \ud Conclusion: Community consultation and a mutually supportive relationship are crucial to the success of this study. The use of a theoretical framework ensures construct and external validity, and although tested in a geographically isolated community, the approach should find wide application and ultimately help to reduce undetected disease while improving CHB diagnosis and treatment rates