Background
Methods
Participants
Study design
Data collection and analysis
Results
Demographic and epidemiologic characteristics of participants
Number of participants | Percentage (%) | |
---|---|---|
Gender | ||
Male | 16 | 57 |
Female | 12 | 43 |
Age Groups | ||
20–39 | 8 | 29 |
40–49 | 10 | 36 |
50–59 | 6 | 21 |
60–69 | 4 | 14 |
Place of Birth | ||
South Korea | 22 | 79 |
United States | 6 | 21 |
Years in the US | ||
< 10 | 4 | 14 |
11–20 | 8 | 29 |
> 20 | 16 | 57 |
Number of participants | Percentage (%) | |
---|---|---|
CHB First Diagnosed | ||
Before 2000 | 21 | 75 |
2000–2010 | 4 | 14 |
After 2010 | 3 | 11 |
Family Historya | ||
Yes | 19 | 68 |
No | 8 | 26 |
Do not know | 1 | 4 |
Level of Educationb | ||
High School | 11 | 39 |
College | 17 | 61 |
Health Insurance | ||
Yes | 16 | 57 |
No | 12 | 43 |
Currently Seeing Physician | ||
Yes | 8 | 29 |
No | 20 | 71 |
Themes identified through content analysis
Theme | Question | Illustrative quotes |
---|---|---|
Part A. Asymptomatic nature of CHB | Do you know what symptoms CHB can give? If there are no symptoms, does this mean you are safe? | Since my HBV infection diagnosis 15 years ago, I have never bothered to see a doctor for it. I never had any symptoms and I have never felt sick except for common colds. If I have symptoms such as easy fatigue or persistent tiredness, I would probably seek a doctor to have a checkup. |
Part B. Chronic nature of CHB | Have you heard of active vs. inactive disease? What do you know about them? | Although I was diagnosed with chronic hepatitis B more than 20 years ago, I never bothered to see a doctor for a checkup. I remember my doctor then telling me that I was a healthy carrier, and I naturally thought I would not have any serious outcomes from this infection. I understand that because my HBV infection is inactive, I don’t need to worry about transmission. It made me feel good since I would not endanger anyone. I remember my CHB was once active when I was first diagnosed, but then in a follow-up, my doctor told me that my infection became inactive subsequently and there was no need to treat it. Since then, I felt no further need to see a doctor for my HB infection. |
Is there a treatment for CHB? | I know there are medicine for CHB, but I don’t think they can cure CHB. So, I don’t consider them as treatment. Heard there is no cure. Don’t think it’s curable for now- Believe new tx will come out soon. I haven’t seen any ads for treatment of Hep B-- believe there is no tx for hep B. | |
Part C. Liver cancer and other complications | Do you know if chronic HBV infection can cause liver cancer and other complications? | If I’m lucky then nothing will happen, but If I am unluckyn, then it will cause other complications I know that CHB can cause liver cancer, but I always felt that it was very rare. I know alcohol drinking can cause bad liver disease. I am not an alcohol drinker, so I am not really worried about liver cancer. Some will develop liver cancer or liver cirrhosis. Never thought about it. I would say higher chance of getting complications. I think liver cancer can happen only to those who are very sick with CHB, with a lot of symptoms and active infection. |
Low risk perception and knowledge of CHB
Theme | Question | Illustrative quotes |
---|---|---|
Language | How difficult is it to communicate with your providers who don’t speak Korean? | I went to see a Chinese doctor, and we had to communicate in English. It was difficult for me to explain my symptoms clearly, and I was not certain if he understood me correctly. I have lived in the United States for the past 32 years, and I consider my English fairly good. However, I find it challenging to explain my concerns about CHB in English. Some of the things often expressed in Korean are expressed very differently from English. You cannot literally translate word for word and expect the meaning to be the same. I only looked for Korean doctors. I have never looked for American doctors due to the language barrier that I knew would be a problem. I do have a fear of interaction with non-Korean doctors at hospitals. I am not sure how to describe the symptoms I have, and I think because of this, I fear that there will be misunderstandings both ways. I went to see a doctor and there was an interpreter, who translated for me. Doctor did not ask many questions, and I am not sure if he understood me. |
Sociocultural | What are the personal issues that affect you when you plan to see a doctor? | Inter-cultural misunderstanding: Doctor I met for hepatitis B explained that I need to come to clinic at least 1–2 times a year to make sure nothing bad has happened in my liver. But I am doing fine so I chose not to go back to the clinic. I do not see why I need a checkup unless I have a symptom. I visit my Eastern medicine acupuncturist for my regular well-being check ups, and I only visit doctor’s office when I am sick. Stress and financial with immigrant life: I definitely feel a certain type of burden when I go to the hospital. I feel that people at the hospital were not as nice as I thought they would be, and I wondered to myself, “Is it because I’m a minority that I’m getting a certain type of treatment?” I used to be a banker in Korea, but I cannot get a decent job here in the US. Fortunately, my wife is a nurse and has a good job. I feel depressed and thinking about going to see a doctor for my liver is not in my mind. Healthcare cost is too high in the US. My employer does not provide health insurance for every employee. And I can’t afford insurance now. Structural: Many of my Korean friends and I rely on the resources from Korean Community Center. I even get my sugar checked there. They provide me with the information about the doctors, pharmacies and hospitals. I was referred to a doctor at a university hospital, but it would take 2 months to see him, so I ended up not going. |
Stigma | What are the personal things you worry about because you are chronically infected? | When I first got diagnosed, I became more careful around other people. I even ate at a different table because I didn’t want to affect my children. I have a girlfriend right now, and I am very troubled since she doesn’t know that I am HB infected. If I tell her, I don’t know how she would react. I’m afraid to tell the truth, so in a way, I feel shame...My doctor told me that if she is vaccinated, it wouldn’t affect her. I mean, there is no chance that she would get hepatitis B from me. But even then, I find it difficult to tell her the truth. |
Language, immigrant status, and stigma
Financial and institutional barriers
Theme | Question | Illustrative quotes |
---|---|---|
Financial | Do you have health insurance that covers doctor’s visit? | I was able to see a doctor regularly until about 10 years ago when I still worked in a large corporation. I had health insurance then. But now, with the insurance cost rising so high, I am not able to afford it. I am 62 years old now, and I will get my Medicare in three years. I had Obamacare until a year ago. The insurance cost keeps rising, and the high copay and deductible payments even with insurance is way too much to afford. So I do not have any health insurance. Fortunately, I don’t feel sick, and I hope my HBV doesn’t cause any serious problem. I know I need to have a checkup soon, though Financial problems are definitely the greatest issue when it comes to seeing a doctor or going to a hospital |
Healthcare system barriers | Have you had any issues with doctors or hospitals you experienced in the United States? | I have been to two doctors in the past several years in the United States. I was not impressed with their level of knowledge and care on CHB. I am not sure how familiar the doctors in the United States are with HBV disease. I think hospital and staff in the United States are not familiar with CHB. I also heard that the national health policy to screen HBV in Asians was only recently instituted. Hospitals in Korea have different systems [than those in the US] that make it easier to seek out care. For example, Korea hardly takes appointments and even when they do, you don’t have to wait long. I went to see an American doctor, who was not familiar with the treatment options for CHB. He referred me to another doctor at a university hospital, but it would take two months to see him, so I ended up not going. As a non-native, it’s difficult to find doctors. Korean community centers and media are the only means for me to find doctors. |