Abstract

Background: Viral hepatitis screening and link to care is a key cancer control strategy to prevent development of liver cancer, especially in underserved populations. We lack data on determinants for viral hepatitis and liver cancer screening and care particularly in geographically spread Asian American (AA) populations.

Methods: We engaged: 1) external stakeholders across Michigan and 2) leaders from 3 Michigan AA communities (Bangladesh, Burmese, Chinese) to identify determinants of viral hepatitis and cancer screening. External stakeholders organizations from state government, community partners, and the Rogel Michigan Medicine Cancer center participated in a focus group to identify broad viral hepatitis and cancer screening and care determinants for Michigan AA communities. We conducted 1:1 semi-structured interviews with 2-5 leaders from each AA community. The interviews assessed 1) general cancer screening, 2) viral hepatitis and liver cancer knowledge and beliefs, 3) health concerns/access. The focus group and interviews were conducted in English, audiotaped and transcribed. A rapid data analysis approach was used to identify key determinants and then grouped by themes informed by the National Institute of Minority Health and Health Disparities Framework.

Results: Eight representatives from external stakeholders participated in the focus group and 11 community leaders from the 3 AA groups participated in interviews. A summary of determinants (barriers [B] and facilitators [F]) is included in the Table grouped by themes. According to AA community leaders, top health concerns included diabetes, hypertension, mental health and chronic diseases. Shared barriers included non-English language, lack of education, misinformation, transportation, lack of insurance, costs of care with insurance, stigma, fear of lost wages and lack of funding for outreach activities. Shared facilitators included trust in community leaders, bilingual services, health education programs and community partnership. Unique determinants within communities included: 1. Burmese: experiencing racism when seeking healthcare (B), multiple dialects within community (B), multiple religious affiliations that further silo communities based on dialects (B), 2. Bangladesh: prior hepatitis outreach activities (F), multisite community organizations (F) and 3. Chinese: positive health messaging (F), reassuring community about treatment options (F), trust in healthcare providers (F). External stakeholders did not identify many determinants raised by AA community leaders representing a learning opportunity.

Conclusion: While many determinants of viral hepatitis and liver cancer outreach efforts are shared across in Michigan AA communities, some barriers and facilitators vary by communities. To adapt or develop viral hepatitis and cancer outreach, tailored interventions to address community specific determinants are needed.