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

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.