Risk Perceptions and Barriers to Hepatitis B Screening and Vaccination among Vietnamese Immigrants

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Abstract
Hepatitis B (HBV) infection plays a primary role in the development of liver cancer, contributing to nearly 80% of liver cancer cases. Vietnamese males have the highest incidence of liver cancer of any ethnic group, and HBV infection is a serious and prevalent health problem among Vietnamese immigrants. Guided by the Health Belief Model framework, the purpose of the present study was to assess levels of perceived risk, severity, barriers and benefits, and cues to action in HBV screening and vaccination in relation to actual screening and vaccination behavior in a sample of Vietnamese adults. The study consisted of 359 Vietnamese adults residing in Pennsylvania and New Jersey. The majority of participants were immigrants (98.1%) and had low socio-economic and educational status. Only 8.8% of participants reported being screened and 7.3% vaccinated for HBV. Participants who had been screened reported feeling at higher risk and perceived HBV infection to be more likely to lead to liver cancer and death than those who had not been screened. In addition, participants who had been screened reported fewer perceived barriers and more cues to action than unscreened participants. Compared to participants who had been vaccinated, unvaccinated participants were more likely to report feeling healthy and a lack of knowledge about where to obtain HBV testing as barriers. Multivariate logistic regression analyses indicated that perceived barriers were negatively associated with screening behavior as well as vaccination behavior. These results suggest that community-based, culturally appropriate interventions for Vietnamese Americans should directly address barriers to screening and vaccination in order to enhance screening and vaccination rates in this underserved population.