H+EAL Outreach Project NYC Arline Loh HepB Patient and Advocate - - PowerPoint PPT Presentation

H+EAL Outreach Project NYC Arline Loh

HepB Patient and Advocate

Challenges for Hep B Outreach in NYC

Patient support group & Screening events

• Population migratory and transient
• Most participant Non documented
• Health is not a priority
• Everyone is looking for a quick fix
• No medical insurance
• Education level and language are real

barrier

• Too busy making a living
• Will not or unable to follow medical advise
• Everyone wants something free

Alternate Model

Hep B Screening with Awareness and Education Goal – To reach a target population with the following characteristics:

• 1. high risk Hepatitis B population that is non-

migratory

• 2. A stable home life
• 3. Have time to take care of their health
• 4. Have some form of medical insurance
• 5. Access to regular medical check ups -

Linkage to care

• 6. Ask for screening at their own initiative

Our Project Team – H+EAL

• Hepatologists – Dr. Maya Gambrain, Dr. Ira Jacobson, Dr.

Sonja Olsen, Dr. Alyson Fox

• Transplant Surgeon – Dr. Tomoaki Kato
• PA & NP
• Epidemiologist
• APAMSA students recruited annually from

all 5 boroughs of NYC

• MPH, Undergrad and Grad students from

Columbia and Cornell

• Co-ordinator

The Model

H + E A L SCHOO L

Adults Adults Adults Adults Adults

Child Child Child Child Child

Project Development

Started in May 2009, Task to develop:

• Alternate Hep B education and awareness model
• Classroom presentation slide deck (revised 3 times)
• Interactive quiz of “Risk or not a Risk factor” card deck
• Interactive skits for students role play in classroom
• 3 surveys – pre-program, post-program and follow- up

surveys (revised 2 twice)

• A comprehensive Hep B pamphlet (duo Language)
• A road map card details the step of Hep B screening

and Risk Factor (duo Language)

• A post card high light the five important Hep B

messages (duo Language)

• Large lamented post card for Clinics waiting area and

treatment room (duo Language)

In class presentation

Beginning of School Year

Pre-presentation survey based on prior knowledge APAMSA Students Interactive lecture & skits Post-presentation survey based on lecture & skits Mid Semester Class Room

1 -2 Months post presentation

Follow-up survey

Presentation Goal

• Students – secondary target to receive Hep B

education and awareness in class room

• Motivate them to take the message home to their

household

• Discuss and educate the Adults (household) –

primary target

• Ultimate goal is Hep B screening for the household
• Awareness to test for HBsAB (5% failure rate for Hep

B vaccination)

Current Project Status

• Started in March 2010
• Three local high school in NYC with Asian student

population ranging from 50-75+% (Hunter College

High, Bronx Science, Stuyvesant High)

• Spring and fall semesters
• Presented to 40 classes with 30+ students each
• Collected three surveys for all classes
• Total – 1200+ students over three years

Surveys

• Pre-program Questionnaire:

41 Questions, focused on prior knowledge and demographic information

• Post-program Questionnaire:

37 questions, focused on knowledge gained and feedback on the program

• Follow-up Questionnaire:

43 questions based on retained information and whether or not they spoke with their parents

Current Data Collection & Entry

• Pre-program Questionairre: 440 entered
• Post-program Questionairre: 399 entered
• Follow-up Questionairre: 354 entered
• Accounts for ~ 30-40% of the total data (1225

collected)

Overall Performance

Hep B Knowledge

40 50 60 70 80 90 100 PreProgram PostProgram FollowUp

“Vaccination against HepB provides protection against HBV infection”

10 20 30 40 50 60 70 80 90 100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

PreProgram PostProgram FollowUp

Demographic Information

Ethnicity

Asian/Pacific Islander White Black Hispanic Other

48.4% 34.2%

Sex

10 20 30 40 50 60 70 80 90 100

Male Female

Access to Healthcare

YES NO I DON’T KNOW Health Insurance? 94.92% 1.39% 3.69% Regular Doctor? 95.62% 1.39% 3.01%

Who Provides Care?

Pediatrician Family Doctor GI Hepatologist ID Other

59% 39%

Hepatitis B Status

Hepatitis B Information

YES NO I DON’T KNOW Have you been diagnosed with HepB? 0% 87.8% 12.2% Have you been vaccinated for HepB?? 36.19% 8.58% 55.22% Have you been tested for Immunity? 6.73% 21.81% 71.46% Have you been treated for HepB? 0% 79.91% 20.09%

Hepatitis B Information

YES NO I DON’T KNOW Has anyone in your household been diagnosed 1.39% 80.79% 17.82% Anyone in your family or a close relative? 6.25% 50.00% 43.75% Does anyone in your family have HCC? 3.74% 69.63% 26.63%

Hepatitis B Information

• How many unique students have someone close to

them with Hepatitis B or HCC? 7.08%

• How many of those students self-identify as Asian or

Pacific Islander? 54.84%

Talking to Parents

• YES: 67.9%
• UNSURE: 18.3%
• I’D LIKE TO BUT DON’T KNOW HOW: 9.5%
• NO: 4.2%
• My parents wouldn’t care
• My family doesn’t have it
• I have other concerns to worry about
• We have already done it
• We have all been vaccinated
• Too lazy

Do you intend to talk to your household?

• 48% have talked to parents
• 31% encouraged them to get screened, and 47%

got screened

• 41% of students got screened
• 33% encouraged their parents to be

vaccinated, and 60% of them were vaccinated

• 78% of the students were vaccinated
• 20% have confirmed antibodies
• BUT this is almost certainly inaccurate…

What happened in the 1-2 months between the program and the follow-up survey?

• 59% will talk to their parents
• 56% will encourage their parents to get

screened, and 45% of students will get screened

• 56% will encourage their parents to get vaccinated
• 56% will confirm that they have antibodies

(immunity) against Hepatitis B

What do you plan on doing in the two months following the follow-up survey?

• Challenges
• They don’t think you’re serious
• Language barrier
• They are very busy/not caring
• They didn’t see the importance
• None, the flyers in Chinese were very helpful
• Awkwardness
• Resources which would help
• Website
• Fast-facts, pamphlet, handout
• Translator
• A reward
• More/better information

Challenges in discussing with parents, what resources would help?

Presentation Feedback

What was most helpful?

10 20 30 40 50 60 70 80 HepB Transmission Hepatitis Prevention Hepatitis B Treatment Healthy Lifestyle Issues Liver Cancer other (specify)

More Feedback

YES NO I DON’T KNOW Were the skits useful? 93.3% 4.3% 2.4% Will you recommend us? 85.4% 3.4% 11.1%

Suggestions to Improve

• None! Good job! You rock!
• More interaction
• Make didactic part shorter
• Move slower with some of the slides with statistic

info

• Make it more detailed, talk about mechanisms of

transmission

• Presenters speak more loudly/be more engaging
• Make it less busy
• Give us handouts to keep
• Skits on ways to talk to parents about HBV

What’s New?

• Revised and shorten the three surveys
• More accessible for students – fewer errors
• More amenable to data entry and analysis
• Reformat the presentation so it is more interactive
• More skits as requested
• Incentivize the students talking to their parents and

convincing them that this is an important issue – CHB is a life long disease and leading cause of HCC for the at risk group.