Cultural tailoring for the promotion of Hepatitis B screening in Turkish Dutch: A protocol for a randomized controlled trial

Erasmus MC, University Medical Center Rotterdam, Dept, of Public Health, the Netherlands.
BMC Public Health (Impact Factor: 2.26). 11/2010; 10(1):674. DOI: 10.1186/1471-2458-10-674
Source: PubMed


Chronic hepatitis B virus infection (HBV) is an important health problem in the Turkish community in the Netherlands, and promotion of screening for HBV in this risk group is necessary. An individually tailored intervention and a culturally tailored intervention have been developed to promote screening in first generation 16-40 year old Turkish immigrants. This paper describes the design of the randomized controlled trial, which will be used to evaluate the effectiveness of the two tailored internet interventions as compared to generic online information on HBV, and to assess the added value of tailoring on socio-cultural factors.
A cluster randomized controlled trial design, in which we invite all Rotterdam registered inhabitants born in Turkey, aged 16-40 (n = 10,000), to visit the intervention website is used. A cluster includes all persons living at one house address. The clusters are randomly assigned to either group A, B or C. On the website, persons eligible for testing will be selected through a series of exclusion questions and will then continue in the randomly assigned intervention group. Group A will receive generic information on HBV. Group B will receive individually tailored information related to social-cognitive determinants of screening. Group C will receive culturally tailored information which, next to social-cognitive factors, addresses cultural factors related to screening. Subsequently, participants may obtain a laboratory form, with which they can be tested free of charge at local health centres. The main outcome of the study is the percentage of eligible persons tested for HBV through to participation in one of the three groups. Measurements of the outcome behaviour and its determinants will be at baseline and five weeks post-intervention.
This trial will provide information on the effectiveness of a culturally tailored internet intervention promoting HBV-screening in first generation Turkish immigrants in the Netherlands, aged 16-40. The results will contribute to the evidence base for culturally tailored (internet) interventions in ethnic minority populations. An effective intervention will lead to a reduction of the morbidity and mortality due to HBV in this population. This may not only benefit patients, but also help reduce health inequalities in western countries.
The Netherlands National Trial Register NTR 2394.

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    • "The HepBFree New Zealand program tested 177,000 people, 5.7 % being HBsAg-positive; significant regional and ethnic differences in HBsAg-positive rates were observed among Maori (5.6 %), Pacific islander (7.3 %), and Asian people (6.2 %) [47]. Successful outreach raised CHB community awareness and led to effective partnerships with local health care providers [47, 59]. "
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    ABSTRACT: Introduction Chronic hepatitis B (CHB) affects over 350 million people worldwide and can lead to life-threatening complications, including liver failure and hepatocellular cancer (HCC). Modern antiviral therapies could stem the rising tide of hepatitis B-related HCC, provided that individuals and populations at risk can be reliably identified through hepatitis B screening and appropriately linked to care. Opportunistic disease screening cannot deliver population-level outcomes, given the large number of undiagnosed people, but they may be achievable through well-organized and targeted community-based screening interventions. Material and methods This review summarizes the experience with community-based CHB screening programs published in the English-language literature over the last 30 years. Results They include experiences from Taiwan, the USA, The Netherlands, New Zealand, and Australia. Despite great variability in program setting and design, successful programs shared common features, including effective community engagement incorporating the target population’s cultural values and the ability to provide low-cost or free access to care, including antiviral treatment. Conclusion While many questions still remain about the best funding mechanisms to ensure program sustainability and what the most effective strategies are to ensure program reach, linkage to care, and access to treatment, the evidence suggests scope for cautious optimism. A number of successful, large-scale initiatives in the USA, Asia–Pacific, and Europe demonstrated the feasibility of community-based interventions in effectively screening large numbers of people with CHB. By providing an effective mechanism for community outreach, scaling up these interventions could deliver population-level outcomes in liver cancer prevention relevant for many countries with a large burden of disease.
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    • "This includes appreciating dietary differences, perception of health and disease management [17] and is especially important in the context of treating populations where religious or strong cultural practices influence behaviour, for example integrating the requirement to fast during Ramadan in treatment plans for Type 2 diabetes mellitus in Muslims. Thus lack of culturally tailored information significantly impairs the ability of the CALD populations to make an informed decision about their health [18]. Participants of this study mention that should this approach be adopted, comprehension of disease and adherence to treatment plans would improve. "
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