‘Honoring tradition, accepting new ways’: development of a hepatitis B control intervention for Vietnamese immigrants

Abstract

Background. Chronic hepatitis B infection rates among Vietnamese‐American adults range from 7 to 14%. Carriers of HBV are over 200 times more likely to develop liver cancer than non‐carriers, and Vietnamese males have the highest liver cancer incidence rate of any ethnic group in the USA (41.8 per 100,000). Culturally and linguistically appropriate interventions are necessary to increase hepatitis B knowledge, serologic testing, and vaccination rates among Vietnamese immigrants.

Methods. The authors engaged in qualitative data collection to inform the development of intervention materials including a video, pamphlet, and barrier‐specific counseling guidelines. Bilingual research assistants conducted 25 open‐ended qualitative interviews and six focus groups focusing on hepatitis B and liver cancer with a convenience sample of Vietnamese‐American men and women living in the Seattle area.

Results. Qualitative findings include beliefs about liver illness and health influenced by traditional Vietnamese and traditional Chinese medicine theory; beliefs about hepatitis B transmission and causes embedded in personal experiences and socio‐historical circumstances; and the value of health and a positive attitude. The video portrays a Vietnamese immigrant family struggling with the new knowledge that their healthy‐appearing son is a hepatitis B carrier. Print materials address knowledge resources and misconceptions about hepatitis B revealed in the qualitative data.

Discussion. Qualitative research provides valuable insight into unanticipated issues influencing health beliefs and behaviors relevant to specific populations and is essential to the development of effective health education materials, which necessarily draw upon local social and cultural contexts. The methods used in this study to develop culturally informed hepatitis B intervention materials for Vietnamese‐Americans translate well for the development of education outreach programs targeting Vietnamese and other immigrants elsewhere.

Keywords:

• Vietnamese Immigrants
• Hepatits B
• Qualitative
• Intervention
• Video

Notes

Correspondence to: Nancy Burke, PhD, UCSF Comprehensive Cancer Center, 74 New Montgomery, Suite 200, San Francisco, CA 94143–0981, USA. Tel: [phone]; Fax: [phone]; Email: [email protected]

Amerasian is the term used to classify children of US citizens by the US Citizenship and Immigration Services (USCIS), referring to children of US soldiers serving in Vietnam.

Most interviews were conducted in participants' homes as this was the most convenient and comfortable setting for participants. When this was not possible (as in two cases) participants came to the project office for interviews.

Factors considered in group size include recognized limitations that groups smaller than four or five do not offer enough variation and groups larger than 15 may be too large for people who may be too shy to speak (Schensul et al. 1999). Previous qualitative studies with Chinese and Cambodian immigrants in Seattle have shown that four to eight participants is ideal (Mahloch et al. 1999; Jackson et al. 2000, 2002).

Very few participants could speak English adequately to have a conversation, but many chose to self‐report their English proficiency at higher rates than observed proficiency.

Five focus group participants were invited for individual interviews as they expressed the desire to discuss their experiences and ideas in more detail than possible within the time and context of the focus group.

Additional information

Notes on contributors

Nancy J. Burke

Correspondence to: Nancy Burke, PhD, UCSF Comprehensive Cancer Center, 74 New Montgomery, Suite 200, San Francisco, CA 94143–0981, USA. Tel: [phone]; Fax: [phone]; Email: [email protected]