Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study.
Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study.
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DOI：
10.1158/1055-9965.epi-12-1399
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发表时间：
2013-05
期刊：
影响因子：
--
通讯作者：
Nguyen TT
中科院分区：
文献类型：
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作者：
Chen MS Jr;Fang DM;Stewart SL;Ly MY;Lee S;Dang JH;Nguyen TT;Maxwell AE;Bowlus CL;Bastani R;Nguyen TT
乙型肝炎相关肝癌不成比例地影响苗族美国人。发病率为18.9/100，000，苗族美国人患肝癌的比率是非西班牙裔白人的6-7倍。B型肝炎病毒（HBV）的血清学检测是通过早期识别高危人群来预防肝癌死亡的主要手段。学术研究人员和苗族领导人合作设计，进行和评估一项为期5年的随机对照试验，测试非专业卫生工作者（LHW）干预，通过家庭教育和患者导航在260名苗族成年人中促进HBV检测。干预组参与者更有可能报告接受HBV血清学检测（24% vs. 10%，p=0.0056），并显示出比对照组参与者更大的知识得分平均增加（1.3 vs. 0.3分，p=0.0003）。多变量模型表明，自我报告的测试收据与干预组分配相关（比值比[OR] 3.5，95%置信区间[CI] 1.3-9.2），知识评分改善（OR 1.3/点，95% CI 1.02-1.7），女性（OR 5.3，95% CI 1.7-16.6），在过去一年基线时看过医生（OR 4.8，95% CI 1.3-17.6）。最常被引用的测试原因是医生的建议。LHWs有效地进行了HBV筛查。看医生和遵守医生的建议是关键。卫生保健提供者的参与对于增加HBV检测至关重要。LHWs可以显着提高苗族的HBV筛查率，但他们的医生的建议是非常有影响力的，应该追求。
Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9/100,000, Hmong Americans experience liver cancer at a rate that is 6–7 times greater than that of non-Hispanic Whites. Serological testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer deaths through earlier identification of those at risk. Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. Intervention group participants were more likely to report receiving serological testing for HBV (24% vs. 10%, p=0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, p=0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.3–9.2), improvement in knowledge score (OR 1.3 per point, 95% CI 1.02–1.7), female gender (OR 5.3, 95% CI 1.7–16.6), and having seen a doctor in the past year at baseline (OR 4.8, 95% CI 1.3–17.6). The most often cited reason for testing was a doctor’s recommendation. LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors’ recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. LHWs can significantly increase HBV screening rates for Hmong, but their doctors’ recommendation is highly influential and should be pursued.