Evaluating an outreach education program to increase uptake and knowledge of hepatitis B testing in Melbourne's Chinese community: CHINA-B study

ABSTRACT

Background and Aim: Hepatitis B is underdiagnosed in Australia, with an estimated 32% of affected people not aware of their hepatitis status. Australia's Chinese community is among the most at-risk populations for hepatitis B an estimated 18% of people living with chronic hepatitis B in Australia were born in China. Identified barriers for hepatitis B testing include lack of awareness and limited knowledge about hepatitis B, and stigma associated with the disease. However, limited data are available on effective approaches to engage Chinese people in hepatitis B testing and care. We therefore conducted an evaluation study of an outreach education program among the Chinese community in Melbourne. The primary aim was to assess the efficacy of the education program on hepatitis B testing uptake and compare the efficacy between two educational resources. The secondary aim was to assess the impacts of the education program on hepatitis B-related knowledge. A nested qualitative study was conducted to assess the feasibility and acceptability of the education program. Methods: We conducted a pilot randomized controlled trial in community sites in Melbourne between July 2019 and June 2020. Adults attending the sites who self-identified as having Chinese ethnicity and were unsure of their hepatitis B status were invited to participate. After completing a baseline hepatitis B knowledge questionnaire, participants were randomly assigned to one of two groups to receive educational information (in either English or Chinese) standard hepatitis B information (Arm 1) or liver cancer prevention information focusing on hepatitis B testing (Arm 2). Participants were followed up by telephone after 6 months to determine whether they had a hepatitis B test and to complete a follow-up questionnaire. The follow-up questionnaire repeated the hepatitis B knowledge questions asked at baseline and explored participants' perceived barriers to testing. A before-and-after comparison of hepatitis B-related knowledge was undertaken. Results: Fifty-four participants were recruited from seven community sites. Participants' median age was 33 years (range, 18-90 years), and most (33, 69%) were female. Thirty-three participants (61%) completed follow-up at 6 months, of whom 22 (67%) were female (median age, 29 years). Among participants followed up, 20 (61%) reported visiting a doctor in the 6 months of follow-up and one third of those (n = 7) reported discussing hepatitis B testing at this GP appointment. Four participants (12%) self-reported having had hepatitis B testing one of 15 (7%) in the standard hepatitis B information group and three of 18 (17%) in the liver cancer prevention information group. Six of 33 participants (18%) reported barriers to having a hepatitis B test, including concerns about accessing health care due to coronavirus disease 2019 and lack of knowledge about how to access health care. Twenty of 33 participants (67%) reported no intention of having a hepatitis B test at follow-up, with the main reason given being do not perceive the risk, do not feel the need. At follow-up after the education program, a significantly lower proportion of participants had the misconception of hepatitis B being transmitted via eating food or sharing eating utensils (8/33, 24%) than at baseline (29/55, 53%) (P < 0.001). The education session was well accepted by participants. Conclusion: A single education session with language-appropriate resources was effective for improving hepatitis B-related knowledge, which was retained at 6 months. However, despite knowledge improvement, a low rate of hepatitis B testing uptake was observed in both groups, with the main barrier being low risk perception in the community.