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 Adults Child SCHOO L Child Adults Child Adults Child Child Adults Adults
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 APAMSA Students Interactive Follow-up lecture & skits survey Pre-presentation Post-presentation survey based on survey based on prior knowledge lecture & skits Beginning of 1 -2 Months post School Year presentation Mid Semester Class Room
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 100 90 80 70 60 50 40 PreProgram PostProgram FollowUp
“Vaccination against HepB provides protection against HBV infection” 100 90 80 70 60 50 40 30 20 10 0 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 48.4% Hispanic 34.2% Other
Sex 100 90 80 70 60 50 40 30 20 10 0 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 39% 59% Hepatologist ID Other
Hepatitis B Status
Hepatitis B Information YES NO I DON’T KNOW Have you been diagnosed with 0% 87.8% 12.2% HepB? Have you been vaccinated for 36.19% 8.58% 55.22% HepB?? Have you been tested for 6.73% 21.81% 71.46% Immunity? Have you been 0% 79.91% 20.09% treated for HepB?
Hepatitis B Information YES NO I DON’T KNOW Has anyone in your household 1.39% 80.79% 17.82% been diagnosed Anyone in your family or a close 6.25% 50.00% 43.75% relative? Does anyone in your family have 3.74% 69.63% 26.63% HCC?
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
Do you intend to talk to your household? • 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
What happened in the 1-2 months between the program and the follow-up survey? • 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 do you plan on doing in the two months following 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
Challenges in discussing with parents, what resources would help? • 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
Presentation Feedback
What was most helpful? 80 70 60 50 40 30 20 10 0 HepB Hepatitis Hepatitis B Healthy Liver Cancer other (specify) Transmission Prevention Treatment Lifestyle Issues
More Feedback YES NO I DON’T KNOW Were the skits 93.3% 4.3% 2.4% useful? Will you 85.4% 3.4% 11.1% recommend us?
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.
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